Whole Body Hyperthermia using Extra-Corporeal ... - Perfusion.com

Whole Body Hyperthermia using Extra-Corporeal 

Membrane Oxygenation and Antegrade Carotid 

Cerebral Perfusion, an effective safe model. 

Ahmses Maat, BS, RRT, CCP, 

Ta Meri Inc., Lake Elsinore, CA, USA 

Ferdinand. Masau, MD, 

Tanzania Heart Institute, Dar es Salaam, TZ 

Disclosures: Ta Meri Inc, 

© 2010 Ahmses S. Maat All Rights Reserved www.TaMeriInc.com

Medline/ Pub Med Search 

ASAIO J. 1996 Jul-Aug;42(4):250-4. 

Induction of whole body hyperthemia with venovenous perfusion. 

Vertrees RA, Tao W, Pencil SD, Sites JP, Althoff DP, Zwischenberger JB. 

Department of Surgery, University of Texas Medical Branch, Galveston 77554-0528, USA. 

Whole body hyperthermia can be used for the treatment of metastatic cancer and human immunodeficiency 

virus infections. The therapeutic effects of hyperthermia are dependent upon the actual temperature of the 

target tissues. Therefore, homogeneous distribution of heat and precise control of temperature gradients is 

critical. To describe heat distribution during hyperthermia induced by venovenous perfusion, the authors used 

multiple channel temperature monitoring and a servo-regulated perfusion/heat exchange system. Young swine 

were randomly assigned to either a heated group (perfusion-induced hyperthermia, target core temperature at 

43 degrees C, n = 6), or a control group (perfusion alone, target core temperature at 38 degrees C, n = 6). Blood 

was drained from the external jugular vein, heated with a computer assisted heat exchange system, and 

reinfused through the femoral vein at a flow of 10 ml/kg-1/min-1. Temperature probes in the esophagus, right 

and left tympanic canals, brain, pulmonary artery, arterial and venous blood, rectus spinae muscle, kidney, 

rectum, bone marrow, bladder, subcutaneous tissue, gluteus, and skin were simultaneously recorded. During 

the heat induction phase, the maximum water temperature was 54 degrees C, with a heating gradient of the 

blood (blood in-blood out) at 6 degrees C. The maximum temperature difference between tissues was 3.6 

degrees C (kidney and esophagus) during heat induction, but decreased to 1.75 degrees C during maintenance. 

Bone marrow temperature was consistently 1-2 degrees C below the average core temperature of 43 degrees C 

throughout the experiment. The authors conclude that venovenous perfusion can predictably induce 

hyperthermia, but is associated with heterogenous temperature distribution among organs. Further studies are 

necessary to evaluate different perfusion and heating patterns to achieve homogenous hyperthermia. 

PMID: 8828779 [PubMed - indexed for MEDLINE] 



ASAIO J. 1997 Sep-Oct;43(5):M830-8. 

Extracorporeal whole body hyperthermia treatments for HIV infection and AIDS. 

Ash SR, Steinhart CR, Curfman MF, Gingrich CH, Sapir DA, Ash EL, Fausset JM, Yatvin MB. 

HemoCleanse Inc., West Lafayette, Indiana 47906, USA. 

Whole body hyperthermia therapy (WBHT) is the elevation of the core body temperature to 42 

degrees C. In vitro studies have confirmed that 42 degrees C is cytocidal for virally infected 

lymphocytes, and even more effective when heating is repeated 4 days later. The safety and efficacy 

of two successive sessions of WBHT (4 days apart) was evaluated in 30 patients with AIDS (not on 

protease inhibitors), randomized to: 1) untreated controls, 2) low temperature WBHT for 1 hour at 40 

degrees C and repeated 96 hours later, and 3) high temperature WBHT for 1 hour at 42 degrees C 

and repeated 96 hours later. The sorbent suspension in the ThermoChem System (HemoCleanse, 

West Lafayette, IN) system automatically controlled blood phosphate, calcium, and other electrolyte 

concentrations during WBHT. In 1 year of follow-up after WBHT, there were positive effects of the 

therapy on frequency of AIDS defining events, Karnofsky score, and weight maintenance. However, 

effects on plasma HIV RNA and CD4 counts were transient. Two successive WBHT treatments were 

performed in four patients who were on protease inhibitor/triple drug therapy, but had suboptimal 

response. In follow-up for 6 months, plasma HIV RNA and CD4 improved after WBHT, and the patients 

remained clinically well. This WBHT may have specific advantages in patients with suboptimal 

response to protease inhibitor therapy. 

PMID: 9360163 [PubMed - indexed for MEDLINE] 



ASAIO Journal: July/August 2002 - Volume 48 - Issue 4 - pp 350-354 

Perfusion Induced Hyperthermia for Oncologic Therapy 

with Cardiac and Cerebral Protection 

Hemmila, Mark R.; Foley, David S.; Casetti, Alfredo V.; Soldes, Oliver S.; Hirschl, Ronald B.; Bartlett, Robert H. 

Abstract 

Cancer can be preferentially damaged and killed at 

temperatures above 41.0° C. However, the heart and 

brain malfunction at this temperature, limiting the 

application of systemic hyperthermia in the treatment of 

metastatic cancer. We created a hyperthermic perfusion 

system that maximizes the temperature differential 

produced and extends the safe hyperthermic time. 




Perfusion Induced Hyperthermia for Oncologic Therapy with Cardiac and Cerebral 

Protection 


Abstract 

• Venoarterial perfusion was instituted and the 

perfusate was warmed to 44 to 45°C. The dogs' 

rectal temperature was elevated to ≥ 42° C for 4 

hours. A small amount of venous blood was cooled 

to 28 to 30° C and reperfused into the right atrium 

to maintain the pulmonary artery temperature ≤ 

38° C. 





Protection 


Abstract 

• Ten of 11 dogs survived the operative procedure, 

and no neurologic deficits were observed. The 

rectal temperature was successfully elevated to ≥ 

42° C for 4 hours while maintaining the heart and 

brain at ≤ 38° C. Moderate serum biochemical 

changes were observed postprocedure. 





Protection 


Abstract 

• Lower abdominal and pelvic hyperthermia at 42° C 

can be safely produced and maintained for 4 hours 

using an extracorporeal perfusion circuit, while 

protecting the heart and brain from temperature 

elevation. 



Immunol Res. 2010 Mar;46(1-3):137-54. 

Diverse immune mechanisms may contribute to the survival benefit seen in 

cancer patients receiving hyperthermia. 

Peer AJ, Grimm MJ, Zynda ER, Repasky EA. 

Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA. 

There is increasing documentation of significant survival benefits achieved in cancer patients 

treated with hyperthermia in combination with radiation and/or chemotherapy. Most evidence 

collected regarding the mechanisms by which hyperthermia positively influences tumor control 

has centered on in vitro data showing the ability of heat shock temperatures (usually above 42 

degrees C) to result in radio- or chemosensitization. However, these high temperatures are 

difficult to achieve in vivo, and new thermometry data in patients reveal that much of the tumor 

and surrounding region is only heated to 40-41 degrees C or less as a result of vascular drainage 

from the target zone of the heated tumor. Thus, there is now a growing appreciation of a role for 

mild hyperthermia in the stimulation of various arms of the immune system in contributing to long 

term protection from tumor growth. Indeed, a review of recent literature suggests the existence 

of an array of thermally sensitive functions which may exist naturally to help the organism to 

establish a new "set point" of immune responsiveness during fever. This review summarizes recent 

literature identifying complex effects of temperature on immune cells and potential cellular 

mechanisms by which increased temperature may enhance immune surveillance. 

PMID: 19756410 [PubMed - in process] 


Hyperthermic Isolated Limb Perfusion 


Hyperthermic Intraperitoneal 

Chemotherapy (HIPEC) 

Cytoreduction 

(Debulking) Surgery 


Whole Body Hyperthermia using Extra-Corporeal Membrane 

Oxygenation and Antegrade Carotid Cerebral Perfusion, 

an effective safe model. 

• Background: Whole Body Hyperthermia (WBH) Heat Shock (HS) level of 

44°C has a proven direct cytocidal effect on cancer and thermo-liable 

pathogens. With WBH, HS, critical Cerebral Hyperthermal Injury (CHI) 

may occur. 

• Purpose: To asses CHI prevention, cerebral hypothermia with 

simultaneous WBH, HS was performed. WBH gives a significant global 

therapeutic HS to all direct and adjoining tissues with vascular access. 

Target temperature for core body is T rectal @ 44°C, and cerebral is T- 

tympanic@ 35°C, respectively. To trial a rapid cerebral cooling the T 

tympanic@ 28°C was earmarked. 


BIZ ≤ 30 

Whole Body Hyperthermia using Extra-Corporeal Membrane Oxygenation and Antergrade Carotid Cerebral Perfusion, an effective safe model. 

Tympanic Temp 35C 

Pulse Ox 96 ±2 

HYPERTHERMIC DIAGRAM 

*Confidential Ta Meri Inc* 

Art by: 

Ahmses Maat ,RRT, CCP, DMD 

Carotid 

Temp 44 

Foley 

Vent 

NG 

EKG 100 

±20 

MAP 80 ± 20 

I.V. 

Fem Art 

ABG 

Pump 2 Pump 1 

Fem Vein 

Sat %/ HCT 

Pedal 

Doppler 

Warming 

Blanket at 42C 

CVP 

15 ±3 

Art 

Line 

Heat 

Exchanger #2 

to 33C 

Oxygenator / Forane 

Heat Exchanger #1 to 

46C 

ABG, K, Na, 

Hct, Glucose 

ACT 

200s+ 





• Methods: Using the Aorta and Right Atria for vascular access on a 35kg 

goat, Extra-Corporeal Membrane Oxygenation (ECMO) was initiated. 

Using a cardioplegia delivery system, a proprietary cerebral protection 

solution was delivered. 

• Right antegrade carotid cerebral perfusion (ACCP) @ 300 ml/min ± 100 

ml/ min at 160 mmHg ± 30 mmHg was achieved and maintained. With 

systemic flows of 2.45 l/m ± 0.45 l/m, the mean BP was maintained at 80 

mmHg ± 20 mmHg. The HR was maintained at 100 ± 40 bpm. The digital 

Pulse Ox and Ear Ox was 96% ± 2%. 

• During systemic warming, the standard 1°C to 2°C gradient range was kept 

within the T-systemic water, arterial, venous, and rectal respectively. The 

pump time was 106 minutes. At 90 minutes, T –rectal @ 44°C and T- 

tympanic @ 35°C was achieved. 

• Then testing rapid cerebral hypothermia, T tympanic @ 28°C was achieved 

within 15 minutes while keeping T rectal@ 44°C. 





• Summary: WBH with ECMO, HS therapy at T rectal 44°C, and ACCP, 

with cerebral hypothermia @ ≤ 35°C was achieved; thereby avoidance of 

CHI is implied. 

• Conclusion: While further study with additional indicators for validity is 

needed, this methodology, offers a potential solution to the threat of cancer 

metastasis and systemic thermo-liable pathogens that are sensitive to 

internal HS treatment while offering avoidance of CHI. 


Tanzania Heart Institute 

Special Thanks for equipment donation to: 

Armando Rosales – Sales- Terumo Cardiovascular Medical 

Paul Johnson CP, Pomona Valley Hospital 

Bill Casey CCP and Monte McKrinstry CCP- Desert 

D`Salaam Regional hosts Hospital continental heart specialists seminar 

By The guardian reporter / www.ippmedia.com 

7th November 2009 

Permanent Secretary in the Ministry of Health and Social Welfare Blandina Nyoni 

will today officiate at the sixth African Heart seminar to be held in Dar es Salaam. 

Briefing reporters in Dar es Salaam yesterday, Tanzania Heart Institute (TAHI) 

founder and president Dr. Ferdinand Masau said the four-day seminar would bring 

together more than 150 medical specialists from different countries across the 

world. 

www.TaMeriInc.com 

HL-Machine, ECMO, VADs, ATS, Cancer 

Hyperthermia 

© 2010 Ahmses S. Maat All Rights Reserved www.TaMeriInc.com 

15

Thank 

You. 

© 2010 Ahmses S. Maat All Rights Reserved www.TaMeriInc.com 

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