A theoretical model of selective cooling using intracarotid cold saline infusion in the human brain

• Published in: Journal of applied physiology (1985) Vol. 102; no. 4; pp. 1329 - 1340
• Main Authors: Konstas, Angelos-Aristeidis, Neimark, Matthew A, Laine, Andrew F, Pile-Spellman, John
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Am Physiological Soc 01.04.2007; American Physiological Society
• Subjects: Biological and medical sciences; Blood Flow Velocity - drug effects; Brain; Brain - blood supply; Brain - drug effects; Brain - physiopathology; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Carotid Arteries; Computer Simulation; Fundamental and applied biological sciences. Psychology; Humans; Hyperthermia, Induced - methods; Hypothermia; Infusions, Intra-Arterial; Mathematical models; Models, Neurological; Saline water; Sodium Chloride - therapeutic use; Stroke - physiopathology; Stroke - therapy; Studies; Temperature; Therapy, Computer-Assisted - methods; Human; Cerebral infarction; spatial and temporal brain temperature distributions; Nervous system diseases; Stroke; Temperature; Cooling; Cold; Central nervous system; Cardiovascular disease; Environmental factor; therapeutic hypothermia; Cerebral disorder; Vascular disease; Vertebrata; Mammalia; Theoretical model; Spatial distribution; Central nervous system disease; Brain ischemia; Cerebrovascular disease; ischemic stroke; Hypothermia
• ISSN: 8750-7587; 1522-1601
• DOI: 10.1152/japplphysiol.00805.2006

Departments of 1 Radiology and 2 Biomedical Engineering, Columbia University, New York, New York Submitted 20 July 2006 ; accepted in final form 12 December 2006 A three-dimensional mathematical model was developed to examine the transient and steady-state temperature distribution in the human brain during selective brain cooling (SBC) by unilateral intracarotid freezing-cold saline infusion. To determine the combined effect of hemodilution and hypothermia from the cold saline infusion, data from studies investigating the effect of these two parameters on cerebral blood flow (CBF) were pooled, and an analytic expression describing the combined effect of the two factors was derived. The Pennes bioheat equation used the thermal properties of the different cranial layers and the effect of cold saline infusion on CBF to propagate the evolution of brain temperature. A healthy brain and a brain with stroke (ischemic core and penumbra) were modeled. CBF and metabolic rate data were reduced to simulate the core and penumbra. Simulations using different saline flow rates were performed. The results suggested that a flow rate of 30 ml/min is sufficient to induce moderate hypothermia within 10 min in the ipsilateral hemisphere. The brain with stroke cooled to lower temperatures than the healthy brain, mainly because the stroke limited the total intracarotid blood flow. Gray matter cooled twice as fast as white matter. The continuously falling hematocrit was the main time-limiting factor, restricting the SBC to a maximum of 3 h. The study demonstrated that SBC by intracarotid saline infusion is feasible in humans and may be the fastest method of hypothermia induction. therapeutic hypothermia; ischemic stroke; spatial and temporal brain temperature distributions Address for reprint requests and other correspondence: M. A. Neimark, Dept. of Biomedical Engineering, Columbia Univ., New York, New York 10027 (e-mail: man2003{at}columbia.edu )