Cerebral perfusion and metabolism after profound hypothermia—comparison between procedures involving no flow and low flow

1993 ◽  
Vol 3 (4) ◽  
pp. 378-382 ◽  
Author(s):  
Rolf Ekroth ◽  
Jan van der Linden ◽  
Christopher Lincoln ◽  
Michael Scallan
Keyword(s):  
Creatine Kinase ◽  
Cardiac Surgery ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Low Flow ◽  
Profound Hypothermia ◽  
Total Circulatory Arrest ◽  
The Brain ◽  
Neural Dysfunction ◽  
Limited Period

The debate concerning no flow versus low flow continues. Thus, it has not yet been possible to conclude whether limited period of total circulatory arrest, as opposed to maintained but reduced systemic flow, offers superior protection of the brain during cardiac surgery in children. While most previous work has focused on the hypothermic period of no versus low flow, less is known about the conditions during and after rewarming with full systemic flow. Some previous data, which related the ischemic marker creatine kinase BB during profound hypothermic procedures, suggested that neural dysfunction was aggravated by posthypothermic factors such as hyperglycemia, acidosis and anemia.

Cerebral cellular response to profound hypothermia

1993 ◽  
Vol 3 (4) ◽  
pp. 383-393 ◽  
Author(s):  
Takao Watanabe ◽  
Masahiko Washio
Keyword(s):  
Carbon Dioxide ◽  
Cellular Response ◽  
Cerebral Metabolism ◽  
Circulatory Arrest ◽  
Low Flow ◽  
Profound Hypothermia ◽  
Flow Perfusion ◽  
Core Cooling ◽  
The Brain ◽  
Brain Tissues

AbstractIn our first two experiments, we examined brain tissue pH and tensions of oxygen and carbon dioxide in dogs core cooled to 20°C. So as to evaluate the effects of 60 minutes of circulatory arrest, 120 minutes of low-flow perfusion (25 mI/kg/mm), and 120 minutes of moderate-flow perfusion (50 mi/kg/mm), all conducted with and without pulsatile assistance. We further determined the effects of blood gas strategy on the same variables with 60 minutes of circulatory arrest. In a third experiment, we directly observed microcirculation at the surface of the brain during profoundly hypothermic perfusion. In the fourth experiment, we measured cerebral blood flow, oxygen consumption, and excessive production of lactate. Profound anoxia occurred within 20 minutes of circulatory arrest, causing severe and progressive acidosis in the brain tissues along with hypercapnia. The inhalation of 5% or 7% carbon dioxide during core cooling made the brain unacceptably acidotic. The brain acidosis was mild with low flow perfusion, and slight with moderate-flow perfusion. Pulsatile assistance improved acidosis in the brain tissues at all rates of flow. It also improved the microcirculation, the patent number of arterioles and stabilized flow in bridging veins. Cerebral metabolism became aerobic without alterations in cerebral consumption of oxygen during low-flow perfusion. We recommend flow rates above 25% of normal, alpha-stat strategy, and pulsatile assistance for better protection of the brain during profound hypothermia.

Clinical neurologic and developmental studies after cardiac surgery utilizing hypothermic circulatory arrest and cardiopulmonary bypass

1993 ◽  
Vol 3 (3) ◽  
pp. 308-316 ◽  
Author(s):  
Gil Wernovsky ◽  
Richard A. Jonas ◽  
Paul R. Hickey ◽  
Adré J. du Plessis ◽  
Jane W. Newburger
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Circulatory Arrest ◽  
Neurodevelopmental Outcome ◽  
Hypothermic Circulatory Arrest ◽  
Cerebral Injury ◽  
Profound Hypothermia ◽  
The Central Nervous System

The dramatic reduction in surgical mortality associated with repair of congenital heart anomalies in recent decades has been accompanied by a growing recognition of adverse neurologic sequels in some of the survivors. Abnormalities of the central nervous system may be a function of coexisting cerebral abnormalities or acquired events unrelated to surgical management (such as paradoxical embolus, cerebral infection, or effects of chronic cyanosis), but insults to the central nervous system appear to occur most frequently during or immediately after surgery. In particular, techniques of support used during neonatal and infant cardiac surgery—cardiopulmonary bypass, profound hypothermia and circulatory arrest—have been implicated as important causes of cerebral injury. This paper will review the effects of bypass and deep hypothermic circulatory arrest on neurodevelopmental outcome.

scholarly journals Clinical Experience with a Closed-chest Method of Producing Profound Hypothermia and Total Circulatory Arrest in Neurosurgery

1964 ◽  
Vol 159 (1) ◽  
pp. 125-131 ◽  
Author(s):  
JOHN D. MICHENFELDER ◽  
JOHN W. KIRKLIN ◽  
ALFRED UIHLEIN ◽  
HENDRIK J. SVIEN ◽  
COLLIN S. MACCARTY
Keyword(s):  
Clinical Experience ◽  
Circulatory Arrest ◽  
Profound Hypothermia ◽  
Closed Chest ◽  
Total Circulatory Arrest
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