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J Thorac Cardiovasc Surg 2005;130:384-392
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Tissue oxygenation index is a useful monitor of histologic and neurologic outcome after cardiopulmonary bypass in piglets

^a Department of Cardiovascular Surgery, Harvard Medical School, Boston, Mass
^b Department of Biostatistics, Harvard Medical School, Boston, Mass
^c Department of Pathology, Harvard Medical School, Boston, Mass
^d Children’s Hospital Boston, Harvard Medical School, Boston, Mass
^e Department of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25–28, 2004.

Received for publication October 7, 2004; revisions received January 4, 2005; accepted for publication February 10, 2005.

^_* Address for reprints: Richard A. Jonas, MD, Department of Cardiovascular Surgery, Children’s National Medical Center, 111 Michigan Ave, Washington, DC 20010 (Email: rjonas{at}cnmc.org).

OBJECTIVE: Tissue oxygenation index is a novel monitoring indicator derived by near-infrared spectroscopy. We hypothesized that tissue oxygenation index could predict a minimum safe flow rate for specific bypass conditions.

METHODS: Thirty-six piglets (age, 43 ± 5 days; weight, 9.0 ± 1.1 kg) underwent cardiopulmonary bypass with cerebral near-infrared spectroscopy (NIRO-300; Hamamatsu Photonics K.K., Hamamatsu City, Japan). Animals were cooled for 40 minutes to 15°C, 25°C, or 34°C (pH-stat, hematocrit value of 20% or 30%, and pump flow of 100 mL·kg^–1 ·min^–1), followed by low-flow perfusion (10, 25, or 50 mL·kg^–1 ·min^–1) for 2 hours. Neurologic and behavioral evaluations were determined for 4 days. The brain was then fixed for histologic assessment. Tissue oxygenation index was defined as the average signal during low-flow bypass.

RESULTS: Animals with an average tissue oxygenation index of less than 55% showed cerebral injury, whereas animals with an index of greater than 55% showed minimal or no evidence of injury. Correlations were found between average tissue oxygenation index and histologic score (Spearman rho = –0.65, P < .001) and neurologic deficit score (Pearson r = –0.50, P = .002) on the first postoperative day. Temperature (P < .001), flow rate (P < .001), and hematocrit value (P = .002) were multivariable predictors of tissue oxygenation index, as determined by means of multivariable analysis of variance.

CONCLUSION: Tissue oxygenation index is a useful monitor for defining the minimum safe flow rate during cardiopulmonary bypass. An index value of less than 55% is a strong predictor of neurologic injury.

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