Cerebral metabolism and circulatory arrest: Effects of duration and strategies for protection

Mault, James R.; Ohtake, Shigeaki; Klingensmith, Mary E.; Heinle, Jeffrey S.; Greeley, William J.; Ungerleider, Ross M.

doi:10.1016/0003-4975(93)90473-u

Cited by 90 publications

(27 citation statements)

References 16 publications

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“…In a study using sheep, Swain et al 46 demonstrated less depletion of high-energy phosphate stores and better preservation of intracellular pH in animals who underwent low-flow cardiopulmonary bypass at 10 ml.kg-l.min -1 and hypothermia than in those undergoing deep hypothermic circulatory arrest. Mault et al, 47 in a study using one-week-old piglets, showed that recovery of cerebral metabolism after rewarming, was almost complete when low-flow cardiopulmonary bypass was employed (reduction of flow from 100 ml.kg-l.min -1 to a flow of between 5-10 ml-kg-l-min -1) during deep hypothermia. In contrast, cerebral metabolism remained impaired after rewarming, in piglets who had undergone deep hypothermic circulatory arrest for a similar duration (60 rain).…”

Section: Low-flow Versus No-flowmentioning

confidence: 99%

Cerebral physiology in paediatric cardiopulmonary bypass

Pua

Bissonnette

1998

Can J Anaesth

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FKCPCPurpose: To analyze studies of neurological injury after open-heart surgery in infants and children and to discuss the effects of cardiopulmonary bypass, hypothermia and deep hypothermic circulatory arrest on cerebral blood flow, cerebral metabolism and brain temperature. Source: Articles were obtained from the databases, Current Science and Medline, from 1966 to present. Search terms include cardiopulmonary bypass(CPB), hypothermia, cerebral blood flow(CBF), cerebral metabolism and brain temperature. Information and abstracts obtained from meetings on the topic of brain and cardiac surgery helped complete the collection of information. Principal findings: In adults the incidence of neurological morbidity is between 7 to 87% with stroke in about 2-5%, whereas the incidence of neurological morbidity increases to 30% in infants and children undergoing cardiopulmonary bypass. Besides the medical condition of the patient, postoperative cerebral dysfunction and neuronal ischaemia associated with cardiac surgery in infants and small children are a combination of intraoperative factors. Deep hypothermic circulatory arrest impairs CBF and cerebral metabolism even after termination of CPB. Inadequate and/or non-homogenous cooling of the brain before circulatory arrest, as well as excessive rewarming of the brain during reperfusion are also major contributory factors. Conclusion: Newer strategies, including the use of low-flow CPB, pulsatile CPB, pH-stat acid-base management and a cold reperfusion, are being explored to ensure better cerebral protection, Advances in monitoring technology and better understanding of the relationship of cerebral blood flow and metabolism during the different modalities of cardiopulmonary bypass management will help in the medical and anaesthetic development of strategies to improve neurological and developmental outcomes.Objectif: Examiner les Etudes portant sur les atteintes neurologiques survenues apr& une chirurgie b. coeur ouvert chez les bEbEs et les enfants et discuter des effets de la circulation extracorporelle, de l'hypothermie et de l'arr~t circulatoire sous hypothermie profonde sur le debit sanguin c&~bral, sur le m&abolisme c&Ebral et sur la temperature du cerveau. Sources documentaires : Des articles ont &E choisis ~ partir de bases de donnEes, Current Science et Medline, de 1966 ~ aujourd'hui. Les mots-cl& utilis& Etaient : circulation extracorporelle (CEC), hypothermie, debit sanguin cErEbral (DSC), mEtabolisme cErEbral et temperature du cerveau. Les informations et les rEsumEs obtenus & la suite de sEminaires sur le cerveau et la chirurgie cardiaque ont permis de completer la cueillette de donn&s. I)onn&s principales : Chez les adultes, l'incidence de morbiditE neurologique avec accident vasculaire est de 7 87 % clans 2 ~. S % des cas tandis que l'incidence de morbiditE neurologique augmente & 30 % chez les bEb~s et les enfants subissant une circulation extracorporelle. La condition mEdicale du patient raise & part, le d&~glement cErEbral postop&atoire et l'ischEmie neu...

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Section: Low-flow Versus No-flowmentioning

confidence: 99%

Cerebral physiology in paediatric cardiopulmonary bypass

Pua

Bissonnette

1998

Can J Anaesth

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“…Once the period of DHCA has been completed and cerebral reperfusion has been initiated, severe cerebral vasoconstriction occurs. There is also an accumulated cerebral oxygen debt from the ischemic period which must be "paid back", and therefore, normal levels of cerebral metabolism are maintained by increased oxygen extraction (10,11,12). During the period following DHCA, the brain is at high risk for both ongoing ischemic injury due to low cerebral blood flow, and reperfusion injury.…”

Section: Wwwintechopencommentioning

confidence: 99%

Cerbral Protection Strategies for

Leshnower¹,

Chen²

2012

Front Lines of Thoracic Surgery

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“…A18 ºC o metabolismo celular é reduzido para 10% dos valores basais em normotermia 35 . A eficácia da hipotermia na proteção encefálica depende de alguns cuidados como: o esfriamento homogêneo do encéfa-lo, obtido pela diminuição lenta da temperatura, e o emprego de gelo em torno da cabeça 36 . Também é recomendado que o aquecimento no final da perfusão seja lento, em velocidade de não mais que 1 ºC por minuto, evitando-se a hipertermia que pode agravar a lesão neurológica pós-parada circulató-ria total 37 .…”

Section: A Hipotermia Profundaunclassified

“…At 18 ºC, cell metabolism is decreased to 10% of normothermal baseline values 35 . Hypothermia efficacy in brain protection depends on some cares, such as: homogeneous cooling obtained by slow temperature decrease and ice around the head 36 . It is also recommended that warming at perfusion completion be slow, in a rate not higher than 1 ºC per minute, preventing hyperthermia which may worsen neurological injury after total circulatory arrest 37 .…”

Section: Deep Hypothermiamentioning

confidence: 99%