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The Journal of Thoracic and Cardiovascular Surgery, Vol 109, Issue 5 959-975, Copyright © 1995 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NOTE: The fulltext of this article is not available online.
C. K. Mezrow, A. Gandsas, A. M. Sadeghi, P. S. Midulla, H. H. Shiang, R. Green, I. R. Holzman and R. B. Griepp
Thirty-two inbred weanling puppies were divided into four groups to study
the effect on cerebral blood flow and metabolism of different hypothermic
strategies for cerebral protection similar to those used during cardiac
operations in infancy. All animals were cooled to 18 degrees C. The animals
in the hypothermic control group were immediately rewarmed. One group
underwent 30 minutes of hypothermic circulatory arrest at 18 degrees C;
another group had 90 minutes of hypothermic circulatory arrest at 18
degrees C, and the final group had low-flow cardiopulmonary bypass (25
ml/kg per minute) at 18 degrees C for 90 minutes. All animals had
preoperative and postoperative neurologic and behavioral evaluation and
extensive intraoperative monitoring of cerebral blood flow, cerebral
vascular resistance, and oxygen and glucose uptake and metabolism:
quantitative electroencephalography was also monitored before, during and
after operation, but those results are reported separately. Two animals in
the 90-minute arrest group died, and all the survivors showed evidence of
clinical, neurologic, and behavioral impairment on postoperative day 1,
with residual abnormalities in all but one animal on day 6. In contrast,
the survivors in all the other groups showed no significant clinical or
behavioral sequelae. Cerebral metabolism was reduced only to 32% to 40% of
baseline values at 18 degrees C in all groups, although systemic metabolism
was only 16% of normal. Cerebral metabolism returned promptly to baseline
in all groups during rewarming and remained at baseline levels throughout
the 8 hours of follow-up. Cerebral blood flow showed marked hyperemia in
the hypothermic arrest groups during rewarming but then significant
reductions below baseline values in all groups except the controls at 2 and
4 hours after the operation, lasting as late as 8 hours after the operation
in the 90-minute arrest group. Cerebral vascular resistance showed
increases in all groups at 2 and 4 hours after the operation, which
persisted in the 90-minute arrest group at 8 hours. Cerebral metabolism was
maintained at baseline levels despite postoperative decreases in cerebral
blood flow and increases in cerebral vascular resistance by increases in
oxygen and glucose extraction. The result was very low sagittal sinus
oxygen saturations in all groups, most marked in the 90-minute arrest
groups, which had a saturation of only 24% 8 hours after the operation. Our
data show a severe, prolonged disturbance in cerebral blood flow and
cerebral vascular resistance after 90 minutes of hypothermic circulatory
arrest at 18 degrees C, which correlates with clinical evidence of cerebral
injury.(ABSTRACT TRUNCATED AT 400 WORDS)
JOURNAL ARTICLE
Metabolic correlates of neurologic and behavioral injury after prolonged hypothermic circulatory arrest
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
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