Cerebral blood flow is determined by arterial pressure and not cardiopulmonary bypass flow rate

Schwartz, Arthur E.; Sandhu, Aqeel A.; Kaplon, Richard J.; Young, William L.; Jonassen, Amy E.; Adams, David C.; Edwards, Niloo M.; Sistino, Joseph J.; Kwiatkowski, Paweł; Michler, Robert E.

doi:10.1016/s0003-4975(95)00357-6

Cited by 81 publications

(30 citation statements)

References 21 publications

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“…It is not necessary to pharmacologically manipulate systemic vascular resistance during CPB, unless it is less than 40-50 mmHg, when the autoregulation of the brain is disrupted, and the cerebral blood flow may decline appreciably, with a concomitant decrease in cerebral oxygen consumption. [33][34][35] …”

Section: Determinants Of Safe Perfusion Blood Flow Ratementioning

confidence: 99%

Extracorporeal Circulation in Cardiac Surgery: Inflammatory response, controversies and Future Directions

2015

Int Arch Med

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One of the milestones in the history of the cardiac surgery is the development of extracorporeal circulation, which allowed hundreds of thousands of patients under successful open cardiac surgery. It´s objective is to maintain the vital organ´s perfusion, provide a bloodless field for surgery, and at the same time, give protection to the heart and lungs. Its principle is to bring most or all of the patient's systemic blood, which normally returns to the right atrium, into an oxygenator in which oxygen is supplied to the blood and carbon dioxide is removed. The arterialized blood is filtered, heated and, pumped into the aorta and the systemic arterial system. But this continuous blood recirculation through nonendothelial surfaces of the perfusion system produces an inflammatory response. Despite all the advantages and strategies developed to try to make the most physiological condition during the extracorporeal circulation, there are still persistent controversies, which we are going to review, as well as the inflammatory response produced by the perfusion system, and it´s future directions.

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Section: Determinants Of Safe Perfusion Blood Flow Ratementioning

confidence: 99%

Extracorporeal Circulation in Cardiac Surgery: Inflammatory response, controversies and Future Directions

2015

Int Arch Med

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“…Therefore, we hypothesize that the pressure in the radial artery is related to cerebral blood flow and not the flow rate. [15] In conclusion, for infants who are scheduled to undergo aortic arch repair with concomitant intracardiac surgical repair, surgery can be safely performed via selective cerebral perfusion at a single stage.…”

Section: Discussionmentioning

confidence: 97%

Aortic arch and intracardiac repair without circulatory arrest in neonates and infants

Karaci¹

2014

Turk Gogus Kalp Dama

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“…Those who have claimed that there is no effect of changing pump flow have studied adults and have reduced pump flow no lower than half of the calculated full requirement. It has been argued that the reduction in CBF is actually related to the reduction in blood pressure that usually occurs in parallel rather than to decreased pump flow per se [121,168,200], and there is some evidence that the capacity of the cerebral circulation to vasodilate is reduced at mean arterial pressures below 40 mmHg during CPB [51]. From a practical point of view, in children undergoing CPB, CBF is reduced at low pump flow.…”

Section: Minimum Pump Flowmentioning

confidence: 99%

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

Kirkham¹

1998

Pediatr Cardiol

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Because of advances in surgical and cardiopulmonary bypass techniques it is now possible to definitively repair the vast majority of congenital heart disease in infancy or childhood. Although the majority of survivors do not have obvious cerebral sequelae, there is increasing disquiet about the high incidence of acute neurological events in the immediated postoperative period as well as evidence that at long-term follow-up there are subtle cognitive and motor deficits in many. Some children are more at risk of neurodevelopmental problems, either because of their cardiac (e.g. , extensive aortopulmonary collaterals) or cerebrovascular (e.g., the propensity to large vessel dissection) anatomy or because of genetic predisposition (e.g., to prothrombotic disorders). The incidence may vary with the surgery (e.g., the Fontan operation) and the cardiopulmonary bypass technique necessary to achieve an adequate technical repair (e.g., low or no flow at deep hypothermia). Recognition of the population at risk will lead to prevention of serious sequelae. Data collected in adults may be misleading, and many pediatric units have developed their own practice, but recent studies in animal models of child surgery and in children have produced some evidence to guide management to ensure the optimal cerebral as well as cardiac outcome. Pump flow should be maintained at least 30 ml/kg/min where possible, with inotropic support to maintain blood pressure if necessary. If pump flow must be lowered or circulatory arrest is essential, thorough cerebral cooling to deep hypothermic temperatures is mandatory; a pH-stat strategy may make this easier, but an alpha-stat strategy may be better in those operations that can be performed at moderate hypothermia. There is no evidence that the available pulsatile pumps offer an advantage. Tissue oxygenation may reach critical levels and a high hematocrit and oxygen tension may reduce the risk of significant hypoxia. There is a risk of embolization in children, which can be reduced with membrane oxygenators and careful monitoring; the role of arterial filtration remains controversial. The only protective agent that can currently be recommended is methylprednisolone to protect the spinal cord (e.g., in operations on the aortic arch). Further studies are needed in this important area.

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Cerebral blood flow is determined by arterial pressure and not cardiopulmonary bypass flow rate

Cited by 81 publications

References 21 publications

Extracorporeal Circulation in Cardiac Surgery: Inflammatory response, controversies and Future Directions

Extracorporeal Circulation in Cardiac Surgery: Inflammatory response, controversies and Future Directions

Aortic arch and intracardiac repair without circulatory arrest in neonates and infants

Recognition and Prevention of Neurological Complications in Pediatric Cardiac Surgery

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