Hypothermic circulatory arrest at 20 ℃ does not deteriorate coagulopathy compared to 28 ℃ in a pig model

Journal of Artificial Organs, vol. 28, pp. 36–42

Abstract

It is believed that a lower temperature setting of hypothermic circulatory arrest (HCA) in thoracic aortic surgery causes coagulopathy, resulting in excessive bleeding. However, experimental studies that eliminate clinical factors are lacking. The objective of this study is to investigate the influence of the temperature setting of HCA on coagulation in a pig model. Ten pigs were divided into the following two groups: moderate temperature at 28 °C (group M, n = 5) or lower temperature at 20 °C (group L, n = 5). Two hours of HCA during a total of 4 h of cardiopulmonary bypass (CPB) were performed. Blood samples were obtained at the beginning (T1) and the end (T2) of the surgery, and coagulation capability was analyzed through standard laboratory tests (SLTs) and rotational thromboelastometry (ROTEM). In SLTs, hemoglobin, fibrinogen, platelet count, prothrombin time, and activated partial thromboplastin time were analyzed. In ROTEM analyses, clotting time and clot formation time of EXTEM, maximum clot firmness (MCF), and maximum clot elasticity (MCE) of EXTEM and FIBTEM were analyzed. Fibrinogen decreased significantly in both groups (group M, p = 0.008; group L, p = 0.0175) at T2, and FIBTEM MCF and MCE also decreased at T2. There were no differences regarding changes in parameters of SLTs and ROTEM between groups. CPB decreases coagulation capacity, contributed by fibrinogen. However, a lower temperature setting of HCA at 20 °C for 2 h did not significantly affect coagulopathy compared to that of HCA at 28 °C after re-warming to 37 °C.

Authors 8

1. Hayato Ise Aachen Department of Cardiac Surgery

   Asahikawa Medical University · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

   Department of Cardiac Surgery, University Hospital RWTH Aachen, Aachen, Germany

2. Kyohei Oyama corresponding

   Asahikawa Medical University

   Affiliation as printed

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan. koyama@asahikawa-med.ac.jp

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

3. Ryohei Ushioda

   Asahikawa Medical University

   Affiliation as printed

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

4. Aina Hirofuji

   Asahikawa Medical University

   Affiliation as printed

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

5. Keisuke Kamada

   Asahikawa Medical University

   Affiliation as printed

   Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

6. Yuri Yoshida

   Asahikawa Medical University

   Affiliation as printed

   Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

7. Payam Akhyari Aachen Department of Cardiac Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Cardiac Surgery, University Hospital RWTH Aachen, Aachen, Germany

8. Hiroyuki Kamiya

   Asahikawa Medical University

   Affiliation as printed

   Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan