A Clinical Study of Cerebral Circulation During Extracorporeal Circulation

Soma, Y; Hirotani, Takashi; Yozu, Ryohei; Onoguchi, Katsuhisa; Misumi, Takahiko; Kawada, Kazuo; Inoue, Tadashi; Mohri, H

doi:10.1097/00132586-198910000-00008

Cited by 3 publications

(8 citation statements)

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“…The observation that warming from moderate hypothermic CPB is associated with jugular venous rate (40-70 ml kg -1 min -1 ). 147 The Bowman Gray group have reported the effects on CBF of alterations in arterial desaturation (Sj O 2 Ͻ50%) suggests that cerebral oxygen extraction during this period exceeds supply. 29 34 In a series pressure with administration of sodium nitroprusside 126 and phenylephrine 127 (measured by 133 Xe clearance) at constant of 255 patients studied at Duke University, the cerebral arteriovenous oxygen difference (Ca O 2 -Cv O 2 ) on rewarming pump flow.…”

Section: Temperaturementioning

confidence: 99%

Central nervous system complications of cardiac surgery

Arrowsmith

Grocott

Rêves

et al. 2000

British Journal of Anaesthesia

252

129

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The neurological complications of cardiac surgery are associated with significantly increased mortality, morbidity and resource utilization. The use of new surgical techniques, introduction of wider indications for surgery and increased public expectation has led to an increase in the average age of cardiac surgical patients and an increased incidence of repeat procedures. With these changes has come an increased risk of neurological complications. The likelihood of perioperative stroke varies between 1% and 5% in most published series and is dependent on a multitude of risk factors. Of these, patient age, aortic atheroma, symptomatic cerebrovascular disease, diabetes mellitus and the type of surgery appear to be most important. Cognitive deterioration after cardiac surgery is far more common, affecting as many as 80% of patients a few days after surgery and persisting in one-third. Despite an increase in the age of the cardiac surgical population, the reported incidence of cognitive dysfunction after cardiac surgery seems to have fallen in recent years. Whether this is a real phenomenon or the result of changes in the use of psychometric testing and the definition of cognitive decline remains unclear. Recognition that certain equipment, surgical practices and patient factors contribute to neurological morbidity has prompted 'neuroprotective' interventions. Some of these (e.g. arterial line filtration and alpha-stat management) have been shown to improve outcome. Despite these measures, a small number of patients will inevitably sustain cerebral injury during otherwise successful cardiac surgery. Although pharmacological neuroprotection may, in the future, offer some of these patients an improved outcome, it is unlikely that any single agent will prevent neurological injury. In the meantime, the CNS complications of cardiac surgery remain a fertile area of research.

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Section: Temperaturementioning

confidence: 99%

Central nervous system complications of cardiac surgery

Arrowsmith

Grocott

Rêves

et al. 2000

British Journal of Anaesthesia

252

129

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“…After removal of duplicates, 866 manuscripts were screened and 86 were identified for full text review. Forty-one that met the inclusion criteria28–68 were included in the analysis (Fig. 3); 6 of these studies were conducted in animals 54–56,59,60,62.…”

Section: Resultsmentioning

confidence: 99%

“…None of the included studies were randomized controlled trials, and all were at high risk of bias across all domains (Selection, Performance, Detection, Attrition, and Reporting) per the Cochrane guidelines. 27 Methods of measuring CBF included cerebral artery mean velocity [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and mean flow assessed using transcranial Doppler (TCD) sonography, 47,48,[50][51][52] radiotracers, [53][54][55][56][57][58][59][60][61][62][63]68 magnetic resonance perfusion, [64][65][66] thermal diffusion flowmetry, 49 and jugular venous oximetry. 67 CO was also measured in a variety of ways including with thermodilution through right-heart catheterization, 29,34,44,45,...…”

Section: Resultsmentioning

confidence: 99%

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Cardiac Output and Cerebral Blood Flow: A Systematic Review of Cardio-Cerebral Coupling

Castle-Kirszbaum¹,

Parkin

Goldschlager³

et al. 2021

Journal of Neurosurgical Anesthesiology

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Control of cerebral blood flow (CBF) is crucial to the management of neurocritically ill patients. Small studies which have examined the role of cardiac output (CO) as a determinant of CBF have inconsistently demonstrated evidence of cardio-cerebral coupling. Putative physiological mechanisms underpinning such coupling include changes in arterial blood pressure pulsatility, which would produce vasodilation through increased oscillatory wall-shear-stress and baroreceptor mediated reflex sympatholysis, and changes in venous backpressure which may improve cerebral perfusion pressure. We sought to summarize and contextualize the literature on the relationship between CO and CBF and discuss the implications of cardio-cerebral coupling for neurocritical care. A systematic review of the literature yielded 41 studies; all were of low-quality and at high-risk of bias. Results were heterogenous, with evidence for both corroboration and confutation of a relationship between CO and CBF in both normal and abnormal cerebrovascular states. Common limitations of studies were lack of instantaneous CBF measures with reliance on transcranial Doppler–derived blood flow velocity as a surrogate, inability to control for fluctuations in established determinants of CBF (eg, PaCO2), and direct effects on CBF by the interventions used to alter CO. Currently, the literature is insufficiently robust to confirm an independent relationship between CO and CBF. Hypothetically, the presence of cardio-cerebral coupling would have important implications for clinical practice. Manipulation of CBF could occur without the risks associated with extremes of arterial pressure, potentially improving therapy for those with cerebral ischemia of various etiologies. However, current literature is insufficiently robust to confirm an independent relationship between CO and CBF, and further studies with improved methodology are required before therapeutic interventions can be based on cardio-cerebral coupling.

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“…Current technology does not permit validation of this concept in humans during cardiopulmonary bypass; however, measurements obtained using a modification of the Kety-Schmidt technique demonstrated a mean CMRO 2 during cardiopulmonary bypass of 0.49 mix 100 g^xmin" 1 at a temperature-uncorrected Paco 2 approximating 46 mmHg at 26.9°C. 31 The authors did not report adjustment of the argon tissue-blood partition coefficient for changes due to hemodilution and hypothermia. Analysis of xenon-133 clearance data during cardiopulmonary bypass demonstrates excellent correlation between the CBF 15 technique and the classical stochastic method.…”

Section: Resultsmentioning

confidence: 99%

Hypercarbia depresses cerebral oxygen consumption during cardiopulmonary bypass.

Prough

Rogers

Stump

et al. 1990

Stroke

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No human studies have systematically examined the relations among Paco 2 , cerebral blood flow, and the cerebral metabolic rate for oxygen during hypothermic cardiopulmonary bypass. We varied Paco 2 during hypothermic (26-28° C) cardiopulmonary bypass and estimated the cerebral metabolic rate for oxygen by multiplying cerebral blood flow (measured using xenon-133 clearance) by the cerebral arteriovenous difference in oxygen contents. Patients were randomly assigned to either of two methods of managing Paco 2 (uncorrected for body temperature). In group 1 (Paco 2 32-48 mm Hg, n=13) the mean±SD cerebral metabolic rate for oxygen was 0.40 ±0.11 ml O 2 xl00 g'xmin"1 at a mean±SD Paco 2 of 36±2.0 mm Hg and 0.40 ±0.14 ml O 2 xl00 g'xmin" Received April 18, 1989; accepted April 19, 1990. have not investigated the effect of systematic changes in Paco 2 on the cerebral metabolic rate for oxygen (CMRO 2 ).23

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A Clinical Study of Cerebral Circulation During Extracorporeal Circulation

Cited by 3 publications

References 0 publications

Central nervous system complications of cardiac surgery

Central nervous system complications of cardiac surgery

Cardiac Output and Cerebral Blood Flow: A Systematic Review of Cardio-Cerebral Coupling

Hypercarbia depresses cerebral oxygen consumption during cardiopulmonary bypass.

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