Feasibility of profound hypothermia as part of extracorporeal life support in a pig model Christoph Weiser, MD, Wolfgang Weihs, DVM, Michael Holzer, MD,

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Feasibility of profound hypothermia as part of extracorporeal life support in a pig model Christoph Weiser, MD, Wolfgang Weihs, DVM, Michael Holzer, MD, Christoph Testori, MD, Anne-Margarethe Kramer, DVM, Christoph Kment, DI, Martin Stoiber, DI, Michael Poppe, Christian Wallmüller, MD, Peter Stratil, MD, Michael Hoschitz, DSc, Anton Laggner, MD, Fritz Sterz, MD The Journal of Thoracic and Cardiovascular Surgery Volume 154, Issue 3, Pages 867-874 (September 2017) DOI: 10.1016/j.jtcvs.2017.03.055 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Future chain of survival with emergency preservation and resuscitation (EPR). The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Brain temperature during flush and bypass. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Fall and rise of hemoglobin during flush and bypass. ECPR, Extracorporeal cardiopulmonary resuscitation. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Lowest brain temperature versus cumulated left subclavian artery pressure during flush procedure. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Labeled digital subtraction angiography during flush of the brain (the tip of the catheter in this picture is slightly too high: in the descending part of the aortic root). The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Future chain of survival with emergency preservation and resuscitation (EPR). The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Drs Weiser and Sterz explain the setup to induce profound hypothermia in cardiac arrest as part of extracorporeal life support (ECLS). The aortic catheter is inserted via the femoral artery and advanced into the descending thoracic aorta. The tip lies in the distal arch with a balloon in the proximal descending aorta to isolate the cerebral circulation. There is also a second balloon that sits in the distal descending aorta. Additional infusion ports between the 2 balloons rapidly infuse cold saline to cool the spinal cord. After completion of the predetermined cerebral and spinal flush infusion, the balloons were deflated, the catheter was removed, and ECLS was initiated. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)30565-2/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 154, 867-874DOI: (10.1016/j.jtcvs.2017.03.055) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions