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NEUROSURGICAL ANESTHESIOLOGY AND NEUROSCIENCE

Deep Hypothermia Attenuates Microglial Proliferation Independent of Neuronal Death After Prolonged Cardiac Arrest in Rats

Tomas Drabek, MD^*, Samuel A. Tisherman, MD, FACS, FCCM^*, Lauren Beuke^*, Jason Stezoski^*, Keri Janesko-Feldman^*, Manuella Lahoud-Rahme, MD^*||, and Patrick M. Kochanek, MD, FCCM^*

From the *Safar Center for Resuscitation Research, University of Pittsburgh; Departments of Anesthesiology, Critical Care Medicine, Surgery, University of Pittsburgh School of Medicine; and ||Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence and reprint requests to Tomas Drabek, MD, Safar Center for Resuscitation Research, 3434 Fifth Ave., Pittsburgh, PA 15260. Address e-mail to drabekt{at}anes.upmc.edu.

Abstract

INTRODUCTION: Conventional resuscitation of exsanguination cardiac arrest (CA) victims is generally unsuccessful. Emergency preservation and resuscitation is a novel approach that uses an aortic flush to induce deep hypothermia during CA, followed by delayed resuscitation with cardiopulmonary bypass. Minocycline has been shown to be neuroprotective across a number of brain injury models via attenuating microglial activation. We hypothesized that deep hypothermia and minocycline would attenuate neuronal death and microglial activation and improve outcome after exsanguination CA in rats.

METHODS: Using isoflurane anesthesia, rats were subjected to a lethal hemorrhagic shock. After 5 min of no flow, hypothermia was induced with an aortic flush. Three groups were studied: ice-cold (IC) flush, room-temperature (RT) flush, and RT flush followed by minocycline treatment (RT-M). After 20 min of CA, resuscitation was achieved via cardiopulmonary bypass. Survival, Overall Performance Category (1 = normal, 5 = death), Neurologic Deficit Score (0%–10% = normal, 100% = max deficit), neuronal death (Fluoro-Jade C), and microglial proliferation (Iba1 immunostaining) in hippocampus were assessed at 72 h.

RESULTS: Rats in the IC group had lower tympanic temperature during CA versus other groups (IC, 20.9°C ± 1.3°C; RT, 28.4°C ± 0.6°C; RT-M, 28.3°C ± 0.7°C; P < 0.001). Although survival was similar in all groups (RT, 6/9; IC, 6/7; RT-M, 6/11), neurological outcome was better in the IC group versus other groups (Overall Performance Category: IC, 1 ± 1; RT, 3 ± 1; RT-M, 2 ± 1; P < 0.05; Neurologic Deficit Score: IC, 8% ± 9%; RT, 55% ± 19%; RT-M, 27% ± 16%; P < 0.05). Histological damage assessed in survivors showed selective neuronal death in CA1 and dentate gyrus, similar in all groups (P = 0.15). In contrast, microglial proliferation was attenuated in the IC group versus all other groups (P < 0.01).

CONCLUSIONS: Deeper levels of hypothermia induced by the IC versus RT flush resulted in better neurological outcome in survivors. Surprisingly, deep hypothermia attenuated microglial activation but not hippocampal neuronal death. Minocycline had modest benefit on neurologic outcome in survivors but did not attenuate microglial activation in brain. Our findings suggest a novel effect of deep hypothermia on microglial proliferation during exsanguination CA.