Skip to Main content Skip to Navigation
Journal articles

The small chill: mild hypothermia for cardioprotection?: Cooling the ischemic myocardium

Abstract : Reducing the heart's temperature by 2-5°C is a potent cardioprotective treatment in animal models of coronary artery occlusion. The anti-infarct benefit depends upon the target temperature and the time at which cooling is instituted. Protection primarily results from cooling during the ischaemic period, whereas cooling during reperfusion or beyond offers little protection. In animal studies, protection is proportional to both the depth and duration of cooling. An optimal cooling protocol must appreciably shorten the normothermic ischaemic time to effectively salvage myocardium. Patients presenting with acute myocardial infarction could be candidates for mild hypothermia since the current door-to-balloon time is typically 90 min. But they would have to be cooled quickly shortly after their arrival. Several strategies have been proposed for ultra-fast cooling, but most like liquid ventilation and pericardial perfusion are too invasive. More feasible strategies might include cutaneous cooling, peritoneal lavage with cold solutions, and endovascular cooling with intravenous thermodes. This last option has been investigated clinically, but the results have been disappointing possibly because the devices lacked capacity to cool the patient quickly or cooling was not implemented soon enough. The mechanism of hypothermia's protection has been assumed to be energy conservation. However, whereas deep hypothermia clearly preserves ATP, mild hypothermia has only a modest effect on ATP depletion during ischaemia. Some evidence suggests that intracellular signalling pathways might be responsible for the protection. It is unknown how cooling could trigger these pathways, but, if true, then it might be possible to duplicate cooling's protection pharmacologically.
Document type :
Journal articles
Complete list of metadatas

Cited literature [31 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-00507838
Contributor : Georges Guellaen <>
Submitted on : Monday, July 11, 2011 - 11:05:19 AM
Last modification on : Friday, October 23, 2020 - 4:35:40 PM
Long-term archiving on: : Wednesday, October 12, 2011 - 2:20:07 AM

Files

cooling_review_-_Tissier.pdf
Files produced by the author(s)

Identifiers

Collections

Citation

Renaud Tissier, Mourad Chenoune, Bijan Ghaleh, Michael Cohen, James Downey, et al.. The small chill: mild hypothermia for cardioprotection?: Cooling the ischemic myocardium. Cardiovascular Research, Oxford University Press (OUP), 2010, 88 (3), pp.406-14. ⟨10.1093/cvr/cvq227⟩. ⟨inserm-00507838⟩

Share

Metrics

Record views

290

Files downloads

622