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J Thorac Cardiovasc Surg 1998;115:1203-1208
© 1998 Mosby, Inc.

CARDIOPULMONARY SUPPORT AND PHYSIOLOGY

Hemodilution and whole body oxygen balance during normothermiccardiopulmonary bypass in dogs

Beng-Ling Liam, MB, BS, MMed(Anaesthesia), Walter Plöchl, MD, David J. Cook, MD, Thomas A. Orszulak, MD, Richard C. Daly, MD

Supported in part by the American Heart Association–MinnesotaAffiliate and the Mayo Foundation.

Received for publication August 15, 1997. Revisions requested Nov. 17, 1997. Revisions received Dec. 17, 1997. Accepted for publication Dec. 22, 1997. Address for reprints: David J. Cook, MD, Department of Anesthesiology,Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

Objective: The purpose of this study wasto determine the minimum hematocrit value that can support whole body oxygenconsumption during normothermic cardiopulmonary bypass. The effect ofhemodilution on peripheral resistance, whole body oxygen delivery, and oxygenconsumption was determined over a range of hematocrit values.
Methods: Measurements were obtained during 38° Ccardiopulmonary bypass with progressive normovolemic hemodilution (hematocritvalue 40% to 9%) in nine dogs. Dextran 70 (6%) was used asa diluent. Anesthesia consisted of high-dose fentanyl and midazolam. A meanarterial pressure of 60 mm Hg was maintained throughout cardiopulmonary bypassvia increases in pump flow.
Results:Progressive hemodilution was associated with a decreasing total peripheralresistance. During normothermic cardiopulmonary bypass with a whole blood prime,the whole body oxygen consumption approximated values previously reported indogs under nonbypass conditions. Oxygen delivery and whole body oxygen uptakewere maintained between a hematocrit value of 39% and 25%.Significant decreases for both were seen when the hematocrit value was reducedto 18% and below.
Conclusions: Ahematocrit level greater than 18% was needed to maintain systemic oxygendelivery and consumption during warm cardiopulmonary bypass. The criticalhematocrit value may be higher under bypass than nonbypass conditions becausethe flow increases that are practical during cardiopulmonary bypass do notapproximate those seen in response to hemodilution of the intact circulation.Finally, the critical hematocrit value for the body may be higher than thatrequired for the brain during warm cardiopulmonary bypass. (J Thorac CardiovascSurg 1998;115:1203-9)




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