Epidural cooling for selective brain hypothermia in porcine model

Background. Hypothermia has been shown to be neuroprotective in many animal models and several human trials of brain ischemic and trauma. However systemic hypothermia may result in fatal complications. This study was undertaken to test epidural cooling as a new method of inducing selective brain hypothermia. Method. Six adult swine (mean mass, 33.8 +/- 3.6 kg) were studied. Anesthesia was maintained with pentobarbital sodium (25mgkg(-1), i.v.) and pancuronium bromide (0.5mgkg(-1)h(-1), i.v.). Five probes were placed in the rectum, deep brain, brain surface, epidural space, and room air for temperature monitoring respectively. Epidural cooling was performed using cold-saline (4 degrees C) perfusion into the epidural space through a flexible double-lumen catheter. The dripping speed of cold saline was controlled to maintain the target temperature. The changes of the epidural space pressure, complete blood counts, basic metabolic panels, tests for fibrinolysis and coagulation status were monitored to assess hypothermia-induced changes. Findings. Following the epidural cooling perfused with cold-saline (4 degrees C) at mean dripping speed of 720ml per hour, the local brain surface temperature could decrease rapidly to 17.3-21.6 degrees C within one minute, and deep brain temperature decreased to 27.2-29.7 degrees C within 5 minutes. The target temperatures were easily controlled by the dripping speed of cold saline (from mild to deep hypothermia). The rectal temperature was maintained at normal range within 6 perfusion hours. No arrhythmia was observed, and all hematological variables were within the normal range for swine. No increased intracranial pressure was induced by the cooling method. Conclusions. The data demonstrate that epidural space cooling was technically feasible and useful for selective brain hypothermia, and the target temperatures are easily controlled. The induction of hypothermia was rapid and maintained for a long period of time, whereas the body temperature was maintained within the normal range and without hemodynamic instability.