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Eur J Cardiothorac Surg 2005;28:259-265
© 2005 Elsevier Science NL

Original articles

In vivo effects of hypothermia on the microcirculation during extracorporeal circulation

^a Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, 45147 Essen, Germany
^b Department of Experimental Surgery, West German Heart Center Essen, University Hospital Essen, 45147 Essen, Germany

Received 17 January 2005; received in revised form 25 April 2005; accepted 26 April 2005.

^* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. Tel.: +49 201 723 4901; fax: +49 201 723 5471. (Email: markus.kamler{at}uni-essen.de).

Abstract

Objective: Induced hypothermia has been shown to be protective during cardiac surgery, but also in traumatic, ischemic, burn, and neurological injury. In previous in vivo animal experiments, we documented increased leukocyte/endothelial (L/E) cell interaction following normothermic extracorporeal blood circulation (ECC). This study was carried out to investigate whether reduced core temperature during ECC affects the damage to the microcirculation as evidenced by leukocyte adherence and edema formation. Methods: Intravital fluorescence microscopy was used on the dorsal skinfold chamber preparation in Syrian golden hamsters. ECC was introduced via a micro-rollerpump (1ml/min) and a 60cm silicon tube (1mm inner diameter) shunted between the carotid artery and the jugular vein after application of 300IE Heparin/kg per body weight. Experiments were performed in chronically instrumented, awake animals (age 10–14 weeks, weight 65–75g). Animals of the experimental group were cooled to 18°C body temperature while ECC, followed by a rewarming period (n=7), controls experienced ECC under normothermia (37°C, n=7). Results: 30min ECC at 18°C resulted in a decrease of rolling and adherent leucocytes (stickers) in postcapillary venules after 1, 4 and 8h compared with the control group (119±46 vs. 274±113n/mm², P<0.05, mean±SD; n=7 in each group). Functional capillary density was significantly reduced during hypothermia (80±16 vs. 148±16cm/cm², P<0.05), but restored after rewarming. In contrast, edema formation was markedly increased during hypothermia. Conclusions: Hypothermia during ECC significantly reduced L/E cell interaction in the early post-ECC period. Hypothermia markedly reduced microvascular perfusion, but was completely restored upon rewarming. Despite a reduced number of adherent leukocytes, no protection of endothelial barrier function was seen as a consequence of induced hypothermia.

Key Words: Microcirculation • Extracorporeal circulation • Leukocyte/endothelial cell interaction • Hamster • Hypothermia

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