Resucitation Or Hibernation?

• Format: Other/Unknown Material
• Language: English
• Published: Morressier 2017
• Subjects: Arctic; Fang; Arctic ground squirrel
• Online Access: https://openresearchlibrary.org/viewer/0ddd4295-96f0-4fd1-a063-5724848d9ac9; https://openresearchlibrary.org/ext/api/media/0ddd4295-96f0-4fd1-a063-5724848d9ac9/assets/external_content.pdf; https://doi.org/10.26226/morressier.5b51cf45b1b87b0009beb785

The essential aim of CPR is the restoration of spontaneous circulation (ROSC). Should we look for other objectives, if we do not get ROSC in a few minutes?After a serious attack all organs need rest, but after a cardiac arrest the heart is required to go back to work with an almost 100% efficiency. Can we allow the heart and brain to rest and recovery after a cardiac arrest? We think so, and here we propose a way to buy time while heart, brain and the whole organism recover from injury.First of all we must protect heart and brain with u03b2 or u03b11 and u03b2 adrenergic blockers and avoid exogenous catecholamines,1,2 while we imitate Nature by a kind of directed and protective hibernation. Hibernation is a genetically defined physiological process, which allows survival during the winter. It consists essentially of a sudden fall in temperature and peripheral and cerebral levels of noradrenaline, dopamine and serotonin. When the winter ends, the process is inverted, catecholamine levels and body temperature increase, and awakening occurs.3-5 We propose the induction of a near-hibernation state based on adrenergic blockade, supported by conventional reduction body temperature, and a subsequent awakening with exogenous catecholamines and body warming when the objectives have been reached.During hibernation circulation should not be completely stopped. We can maintain an effective hypodynamic circulation with a pump and a veno-venous circuit, supported by a cardio-compressor at very low heart rate. The low CO2 generated can be removed with 2 or 3 either invasive or non-invasive mechanical ventilations per minute. In each case we must decide the dose of u03b11 and u03b2 adrenergic blockers, the heart rate of the cardiocompressor, the flow of the veno-venous extracorporeal circulation device, the time of hibernation and the doses of catecholamines for awakening.1.tKurita A, Taniguchi T, Yamamoto K. The effects of carvedilol administration on cardiopulmonary resuscitation in a rat model of cardiac arrest induced by airway obstruction. Anesth Analg. 2010;111(5):1207-10. 2.tHuang L, Sun S, Fang X, Tang W, Weil MH. Simultaneous blockade of alpha1- and beta-actions of epinephrine during cardiopulmonary resuscitation. Crit Care Med. 2006;34(12 Suppl):S483-S485. 3.tFeist DD, Galster WA. Changes in hypothalamic catecholamines and serotonin during hibernation and arousal in the arctic ground squirrel. Comp Biochem Physiol A Comp Physiol. 1974;48(4):653-62.4.tLyman CP, Chatfield PO. Physiology of hibernation in mammals. Physiol Rev 1955;35:403-425.5.tFlorant GL, Wettzman ED, Jayant A, Cote LJ. Plasma catecholamine levels during cold adaptation and hibernation in woodchucks (Marmota monax). J Therm Biol 1982; 7:143-146.