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J Thorac Cardiovasc Surg 1995;110:774-0785
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Tissue oxygenation with graded dissolved oxygen delivery during cardiopulmonary bypass

Birmingham, Ala., and San Diego, Calif.

Supported by a grant from Alliance Pharmaceutical Corp., San Diego, Calif. Walter V.A. Vicente is supported by a great from CNPq Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil. This work was performed during William L. Holman's tenure as an Established Investigator for the American Heart Association.

Received for publication Oct. 24, 1994. Accepted for publication Feb. 17, 1995. Address for reprints: William L. Holman, MD, Department of Surgery, University of Alabama at Birmingham, University Station, Birmingham, AL 35294.

Abstract

Background: Intravascular perfluorochemical emulsions together with a high oxygen tension may increase the delivery of dissolved oxygen to useful levels. The hypothesis of this study is that increasing the dissolved oxygen content of blood with incremental doses of a perfluorochemical emulsion improves tissue oxygenation during cardiopulmonary bypass in a dose-related fashion.
Methods and Results: Oxygen utilization was studied in a profoundly anemic canine model of hypothermic cardiopulmonary bypass. Forty-two dogs (mean±standard error of the mean). Cardiopulmonary bypass was begun and resulted in a hematocrit of 9.4% + 0.6%. A standard primng solution was used in the control group (n = 12), and the test groups received 1.35 gm perfluorochemical · kg^-1(n = 10 dogs), or 5.4 gm perfluorochemical · kg^-1(n = 10 dogs), 2.7 gm perfluorochemical · kg^-1(n = 10 dogs) through the venous return cannula. Each animal underwent a series of randomized pump flows (0.25,0.5, 1.0, 1.5, 2.0, and 3.0 L · min^-1· m^-2) at 32° C. After the randomized flows were completed at 32° C, the temperature was raised to 38° C and cardiopulmonary bypass was discontinued. Mortality from cardiac failure on separation from cardiopulmonary bypass was 42% in the control group and 20% in perfluorochemical-treated groups. The mean perfluorochemical dose was higher in surviviors than in nonsurvivors (2.9+0.4 versus 1.3+0.5 gm perfluorochemical · kg^-1;p < 0.05). No differences in oxygen consumption or transbody lactate gradient were found between groups during cardiopulmonary bypass. Analysis of mixed venous oxygen tension (a surrogate measure for tissue oxygenation) as a function of cardiopulmonary bypass flow normalized to body surface area showed that the control group had significantly lower mixed venous oxygen tension (p < 0.05) than the perfluorochemical emulsion-treated groups. Furthermore, the differences were related to the perfluorochemical emulsion dose. These differences in mixed venous oxygen tension continued after termination of cardiopulmonary bypass. The coronary sinus oxygen tension and cardiac arterial-venous oxygen content differences during and after cardiopulmonary bypass were similar among the control and perfluorochemical emulsion-treated animals. Dissolved oxygen consumption during and after cardiopulmonary bypass was calculated. Dissolved oxygen consumption increased in the perfluorochemical-treated animals in a perfluorochemical dose-related manner and was significantly higher in perfluoro-chemical-treated animals than in the control animals (p<0.05). Conclusions:Graded increases in mixed venous oxygen tension during cardiopulmonary bypass were observed in response to graded increases in the dissolved oxygen delivery. These data suggest that enhancing oxygenation with perfluorochemical-dissolved oxygen is an effective temporary substitute for the use of hemoglobin-bound oxygen during cardiopulmonary bypass. Perfluorochemical-dissolved oxygen may be particularly beneficial in the setting of multiple hypoxic stresses. (J THORACCARDIOVASCSURG1995;110: 774-85)

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