Comparison of neurologic outcome after deep hypothermic circulatory arrest with alpha-stat and pH-stat cardiopulmonary bypass in newborn pigs

Abstract

pH-stat cardiopulmonary bypass management improves neurologic outcome with deep hypothermic circulatory arrest compared with alpha-stat bypass. The mechanism of protection is not related to hemodynamics, hematocrit, glucose, or brain temperature.

Neurobehavioral functional deficits following closed head injury in the neonatal pig

“…Previous survival studies of acute brain injury in piglets have utilized limited and relatively unsophisticated neurobehavioral assessments (Agnew 2003,Priestley 2001). Priestley et al utilized a simple neurologic performance scale and a functional disability score that evaluated piglets' ability to feed, ambulate, and explore their environment.…”

“…mental status, cranial nerves, sensorimotor function, feeding), each of which is assigned a graded score of 1-4 representing the degree of abnormality, yielding a final score ranging from a possible total of 9 for the simplest grading scheme (Midulla 1994), to 150 for a more complicated neurological deficit score (Agnew 2003). These grading systems have shown only limited correlation with histopathologic abnormalities (Priestley 2001), but their sensitivity for assessment of complex behavior or cortical functions is poor, and none have been well validated with long-term survival studies.…”

Use of Hemoglobin Vesicles During Cardiopulmonary Bypass Priming Prevents Neurocognitive Decline in Rats

“…10 The neurologic performance scale 11 consisted of a physical examination with points given for deficits. A normal examination score was 0, and the worst score was 95.…”

Anestesia para o recém-nascido submetido a cirurgia cardíaca com circulação extracorpórea

“…Um estudo com 182 lactentes submetidos à hipotermia profunda e PCT demonstrou que o grupo tratado pela estratégia pH stat teve menor morbidade, menor tempo para a recuperação da atividade eletroencefalográfica, mais rápida recuperação e, em subgrupos com lesões cardíacas específicas, menor tempo de assistência ventilatória e permanência na unidade de terapia intensiva 45 , enquanto outro estudo não detectou diferenças na avaliação neurocompor-tamental entre crianças conduzidas segundo as duas estratégias 46 . Estudo comportamental e histológico feito em porcos recém-nascidos submetidos à hipotermia profunda e parada circulatória total por 90 minutos sugere benefícios para o sistema nervoso central com a estratégia pH stat 47 . Deve-se ter cautela, porém, com a interpretação de resultados obtidos a partir de estudos em animais.…”

“…A study with 182 infants submitted to deep hypothermia and TCA has shown that the pH stat strategy group had lower incidence of morbidity, shorter ECG activity recovery time, faster recovery and, in subgroups with specific heart defects, shorter ventilatory assistance and ICU stay 45 , while a different study has not detected differences in neurobehavioral evaluation of children managed by both strategies 46 . A behavioral and histological study with piglets submitted to deep hypothermia and total circulatory arrest for 90 minutes has suggested central nervous system benefits with pH stat strategy 47 . Care must be taken, however, with the interpretation of animal experiment results.…”