Comparison of Retrograde Cerebral Perfusion to Antegrade Cerebral Perfusion and Hypothermic Circulatory Arrest in a Chronic Porcine Model

Midulla, Peter; Gandsas, Alejandro; Sadeghi, Ali; Mezrow, Craig K.; Yerlioglu, M. Enver; Wang, Wiejia; Wolfe, David; Ergin, Mehmet; Griepp, Randall B.

doi:10.1111/j.1540-8191.1994.tb00889.x

Cited by 77 publications

(11 citation statements)

References 10 publications

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“…Typically a series of 4 or 5 categories of neurological function are used (e.g. 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.…”

Section: Introductionmentioning

confidence: 99%

Neurobehavioral functional deficits following closed head injury in the neonatal pig

Friess

Ichord

Owens

et al. 2007

Experimental Neurology

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Neurobehavioral deficits in higher cortical systems have not been described previously in a large animal model of diffuse brain injury. Anesthetized 3-5 day old piglets were subjected to either mild (142 rad/sec) or moderate (188 rad/sec) rapid non-impact axial rotations of the head. Multiple domains of cortical function were evaluated 5 times during the 12 day post-injury period using tests of neurobehavioral function devised for piglets. There were no observed differences in neurobehavioral outcomes between mild injury pigs (N = 8) and instrumented shams (N = 4). Moderately injured piglets (N = 7) had significantly lower interest in exploring their environment and had higher failure rates in visual-based problem solving compared to instrumented shams (N = 5) on Day 1 and 4 after injury. Neurobehavioral functional deficits correlated with neuropathologic damage in the neonatal pigs after inertial head injury. Injured axons detected by immunohistochemistry (β-APP) were absent in mild injury and sham piglets, but were observed in moderately injured piglet brains. In summary, we have developed a quantitative battery of neurobehavioral functional assessments for large animals that correlate with neuropathologic axonal damage and may have wide applications in the fields of cardiac resuscitation, stroke, and hypoxicischemic brain injury.

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Section: Introductionmentioning

confidence: 99%

Neurobehavioral functional deficits following closed head injury in the neonatal pig

Friess

Ichord

Owens

et al. 2007

Experimental Neurology

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“…Midulla et al [6] randomized 28 pigs into one of four groups: HCAA, HCA-HP, RCA or ACP. All animals were placed on CPB and cooled to 20°C, before undergoing their randomized intervention for 90 min, then rewarmed to 30°C.…”

Section: Resultsmentioning

confidence: 99%

Is it worth packing the head with ice in patients undergoing deep hypothermic circulatory arrest?

O'Neill

Bilal²,

Mahmood

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is it worth packing the head with ice in patients undergoing deep hypothermic circulatory arrest (DHCA)? Altogether more than 34 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question, 5 of which were animal studies, 1 was a theoretical laboratory study and 1 study looked at the ability to cool using circulating water 'jackets' in humans. There were no available human studies looking at the neurological outcome with or without topical head cooling with ice without further adjunct methods of cerebral protection. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four papers studied animals undergoing DHCA for 45 min-2 h depending on the study design, with or without packing the head with ice. The studies all demonstrated improved cerebral cooling when the head was packed with ice during DHCA. They also illustrated an improved neurological outcome, with better behavioural scores (P < 0.05), and in some, survival, when compared with animals whose heads were not packed in ice. One study examined selective head cooling with the use of packing the head with ice during rewarming after DHCA. However, they demonstrated worse neurological outcomes in these animals, possibly due to the loss of cerebral vasoregulation and cerebral oedema. One study involved a laboratory experiment showing improved cooling using circulating cool water in cryotherapy braces than by using packed ice. They extrapolated that newer devices to cool the head may improve cerebral cooling during DHCA. The final study discussed here demonstrated the use of circulating water to the head in humans undergoing pulmonary endarterectomy. They found that tympanic membrane temperatures could be maintained significantly lower than bladder or rectal temperatures when using circulating water to cool the head. We conclude that topical head cooling with ice is of use during DHCA but not during rewarming following DHCA and that it may be possible to advance topical head cooling techniques using circulating water rather than packed ice.

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“…[1,3,8,12] Buna rağmen güvenli ısı aralığında halen kesin bir görüş birliği sağlanamamıştır. [13][14][15][16][17][18] Bazı çalışmalarda optimal ısıların 18 °C -22 °C'ye yükseltilebileceği belirtmiştir. [4,[19][20][21] Kliniğimizde özellikle diseksiyon hastalarında daha güvenli bulduğumuz, 16 °C -18 °C derin hipotermi aralığı tercih edilmekteyken, antegrad selektif serebral perfüzyon uygulanan hastalarda brakiyosefalik artere klemp sonrası açık distal teknik ile güvenli distal anastomoz uygulanmaktadır.…”

Section: Discussionunclassified

Analysis of risk factors affecting mortality in proximal aortic surgery

Üstünsoy¹

2014

Turk Gogus Kalp Dama

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Bu çalışmada proksimal aort cerrahisi uygulanan hasta grubunda mortaliteyi artıran risk faktörleri araştırıldı. Ça lış mapla nı:Ocak 2002-Haziran 2009 tarihleri arasında toplam 183 hasta (116 erkek, 67 kadın; ort. yaş 59±14 yıl; dağılım 23-82 yıl) çalışmaya alındı. Ameliyat öncesi risk faktörleri hastaların 159'unda (%86.8) hipertansiyon, 68'inde (%37.1) ileri yaş, 26'sında (%14.2) tip 2 diyabet, 23'ünde (%12.5) kronik obstrüktif akciğer hastalığı, 106'sında (%57.9) sigara içiciliği, 16'sında (%8.7) nefropati ve 14'ünde (%7.6) serebrovasküler hastalık idi. Koroner anjiyografi yapılmadan ameliyata alınan tip A diseksiyonlu 79 hasta hariç çıkan ve arkus anevrizmalı 104 hastanın 21'inde (%20.1) koroner arter hastalığı vardı. Hastaların yedisi (%3.8) daha önceden sternotomi gerektiren açık kalp ameliyatı geçirmişti. Çıkan aort patolojisi, patolojik segmente hangi düzeyde müdahale edildiği, kanülasyon teknikleri, serebral koruma yöntemleri ve hastalara ait ameliyat öncesi morbidite faktörleri ile ameliyata bağlı değişkenlerin mortalite ve morbiditeye olan etkileri değerlendirildi. Bul gu lar: Hastane mortalite oranı tüm hasta grubunda %15.3 idi (diseksiyon hastalarında %20.2, anevrizma hastalarında %11.5). Çok değişkenli regresyon analizinde ileri yaş (4.31 kat), kronik obstrüktif akciğer hastalığı (2 kat), arkusa uzayan replasman (5.3 kat), uzamış kardiyopulmoner baypas süresi (4 kat), ameliyat öncesi hemodinamik instabilite (5.7 kat), ameliyat öncesi ve ameliyat sonrası nefropati (1.6 ve 2.4 kat), santral nöropati (3.7 kat), ameliyat sonrası kalıcı nörolojik defisit (7.14 kat) ve vital organ malperfüzyonun (12.5 kat) mortaliteyi artırdığı bulundu. So nuç: Proksimal aort cerrahisi kabul edilebilir mortalite ve morbidite oranları ile uygulanmaktadır. Ancak çalışmamızda acil cerrahi girişim gerektiren akut tip A aort diseksiyonlu hastalarda ameliyat öncesi veya ameliyat sırası gelişen organ malperfüzyonunun cerrahi başarıyı belirgin olarak düşürdüğü gözlemlendi. Anah tar söz cük ler: Malperfüzyon; proksimal aort cerrahisi; risk faktörleri. Background:In this study, we aimed to investigate the incremental risk factors for mortality in patients undergoing proximal aortic surgery. Methods: Between January 2002 and June 2009, a total of 183 patients (116 males, 67 females, mean age: 59±14 years; range 23 to 82 years) were enrolled in this study. The preoperative risk factors were hypertension in 159 patients (86.8%), advanced age in 68 (37.1%), type 2 diabetes in 26 (14.2%), chronic obstructive pulmonary disease in 23 (%12.5), smoking in 106 (57.9%), nephropathy in 16 (8.7%), and cerebrovascular disease in 14 (7.6%). Except 79 patients with type A dissection who underwent surgery without coronary angiography, out of 104 patients with ascendant and arch aneurysm, 21 had coronary artery disease (20.1%). Seven patients (3.8%) previously underwent open heart surgery requiring sternotomy. The effects of the ascending aortic pathology, extent of the intervention to the pathological segment, cannulation techniques, methods of cer...

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Comparison of Retrograde Cerebral Perfusion to Antegrade Cerebral Perfusion and Hypothermic Circulatory Arrest in a Chronic Porcine Model

Cited by 77 publications

References 10 publications

Neurobehavioral functional deficits following closed head injury in the neonatal pig

Neurobehavioral functional deficits following closed head injury in the neonatal pig

Is it worth packing the head with ice in patients undergoing deep hypothermic circulatory arrest?

Analysis of risk factors affecting mortality in proximal aortic surgery

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