Effectiveness Of A Cholangio Cooling Method Using4℃Cold Solution In Liver Trauma

Background and Objective:The liver is the most frequently injured organ following abdominal trauma despite itsrelatively protected location. The liver will always be affected in the right abdominaltrauma, and road traffic accidents and antisocial, violent behaviors account for the majorityof liver injuries. When the liver is injured, liver trauma can cause a lot of blood loss andmassive release of inflammatory cytokines, making the body to produce severehypotension shock and inflammation. Therefore, rapid transit and rescue measures shouldbe established immediately after the liver damage. This process became a race against time,so the treatment during this phase seems to be very important.Cold infusions have proved to be effective for induction of therapeutic hypothermiaafter cardiac arrest but so far have not been used for the liver injury. Our objective was todetermine the efficacy of a Cholangio Cooling Method using4°C cold solution on thephysiologic response to liver injury in a prospective, randomized, blinded animal study.This study evaluates the liver cooling effect of infusing cold fluid through the bileduct, and investigates whether hypothermia has a protective effect on the liver. We soughtto develop a reliable hemorrhagic model of hepatic injury that will allow for this newresearch in the field of liver trauma.Methods:The design proposal was supposed to simulate actual emergency treatment. We use twopieces of scalpel blade to inflict a standardized Grade II injury to the right upper lobe ofthe liver of13anesthetized swine. After15minutes of uncontrolled hemorrhage and1hoursimple treatment such as liver packing and initial fluid resuscitation, subjects wererandomly divided into two groups treated with abdominal surgery, one group receivedstandard resuscitative measures, and another group used an extra cholangio cooling methodwith4°C lactated Ringer’s solution. All subjects were monitored for7days to evaluate theeffect of this hypothermia approach. Samples of the liver were taken for Histopathologicevaluation.Results:Two subjects died before the end of the study, and the others survived. All the animalshad their initial surgery performed by surgeons of the Eastern Hepatic Biliary SurgicalHospital (EHBH). For the heart rate and MAP, there were no significant differences between the two groups at any time point. All the animals experienced a transient decreasein blood pressure, but no other haemodynamic side effects were observed. After2hoursintervention, the liver temperature dropped1.17±0.68℃and2.08±0.21℃respectively (Control group versus Hypothermia group: P=0.020). Maintaining the targettemperature was possible in the cholangio infusion group and no adverse events wereobserved. Since the distributions of the transaminase indexes are skewed, the indexes oflog (ALT) and log(AST) was used. The significant difference of the log (AST) occurredafter2hours infusion(P=0.026), meanwhile the significant difference of the log (ALT)occurred5days after the operation (P=0.016). For the histopathologic evaluation,parenchymal inflammatory cell infiltration in the hypothermia group was significantly lesssevere.Conclusions:Cholangio infusion of4°C cold solution is effective in inducing and maintainingtherapeutic hypothermia to promote the recovery of liver function of the hemorrhagic liverinjury model.