HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James R. Mault Shigeaki Ohtake Jeffrey S. Heinle Ross M. Ungerleider Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mault, J. R. Articles by Ungerleider, R. M. Search for Related Content PubMed PubMed Citation Articles by Mault, J. R. Articles by Ungerleider, R. M.

Ann Thorac Surg 1993;55:57-64
© 1993 The Society of Thoracic Surgeons

---

Articles

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

Departments of Surgery and Anesthesiology, Duke University Medical Center, Durham, North Carolina USA

^_* Address reprint requests to Dr Mault, Duke University Medical Center, Box 3642, Durham, NC 27710.

Hypothermic total circulatory arrest (CA) is commonly used to facilitate repair of complex congenital heart defects. However, the "safe" period of CA remains to be defined. Extended periods of hypothermic total circulatory arrest may impair cerebral metabolism and cause ischemic brain injury. This study defines the relationship between increasing durations of CA at 18 °C and cerebral metabolism, and examines the protective value of topical cooling of the head or continuous "trickle" flow (5 to 10 mL · kg^–1 · min^–1). Thirty-three 1-week-old piglets were randomized to six experimental groups: control; 15, 30, or 60 minutes of CA; 60 minutes of CA with topical cooling of the head; and 60 minutes of trickle flow. Animals were placed on cardiopulmonary bypass (CPB) at 100 mL · kg^–1 · min^–1 and cooled to 18 °C. After the experimental period of CA or trickle flow (or 60 minutes of CPB at normal flow for the control group), animals were rewarmed to 37 °C and weaned from CPB. Data were obtained before and immediately after CPB at 37 °C, and before and immediately after the experimental period at 18 °C. Parameters measured included cerebral blood flow by xenon 133 clearance, arterial and sagittal sinus blood gases, and cerebral metabolism. Hypothermic total circulatory arrest caused an impairment of cerebral metabolism that was directly proportional to CA duration (r ² = 0.73; p = 0.0001), and recovery of metabolic function after 60 minutes of CA improved more than 50% if the head was packed in ice. If technically feasible, CPB flow of only 5 to 10 mL · kg^–1 · min^–1 during hypothermia is superior to CA with respect to cerebral protection. Future studies with this model can be used to develop optimal modes of cerebral protection during neonatal heart operations.

This article has been cited by other articles:

				R. Pretre and M. I. Turina Deep Hypothermic Circulatory Arrest Card. Surg. Adult, January 1, 2008; 3(2008): 431 - 442. [Full Text]

				E. J. Hickey, X. You, V. Kaimaktchiev, and R. M. Ungerleider Hypoxemic reperfusion exacerbates the neurological injury sustained during neonatal deep hypothermic circulatory arrest: a model of cyanotic surgical repair Eur J Cardiothorac Surg, May 1, 2007; 31(5): 906 - 914. [Abstract] [Full Text] [PDF]

				I. Dorotta, P. Kimball-Jones, and R. Applegate II Deep hypothermia and circulatory arrest in adults. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 66 - 76. [Abstract] [PDF]

				T. Jones and M. Elliott Paediatric CPB: Bypass in a High Risk Group Perfusion, July 1, 2006; 21(4): 229 - 233. [Abstract] [PDF]

				T.-Y. Hsia and P. J. Gruber Factors Influencing Neurologic Outcome After Neonatal Cardiopulmonary Bypass: What We Can and Cannot Control Ann. Thorac. Surg., June 1, 2006; 81(6): S2381 - S2388. [Abstract] [Full Text] [PDF]

				J. M. Schultz, T. Karamlou, I. Shen, and R. M. Ungerleider Cardiac Output Augmentation During Hypoxemia Improves Cerebral Metabolism After Hypothermic Cardiopulmonary Bypass Ann. Thorac. Surg., February 1, 2006; 81(2): 625 - 633. [Abstract] [Full Text] [PDF]

				V. Anttila, I. Hagino, D. Zurakowski, Y. Iwata, L. Duebener, H. G.W. Lidov, and R. A. Jonas Specific Bypass Conditions Determine Safe Minimum Flow Rate Ann. Thorac. Surg., October 1, 2005; 80(4): 1460 - 1467. [Abstract] [Full Text] [PDF]

				S. S. L. Tsui, J. M. Schultz, I. Shen, and R. M. Ungerleider Postoperative hypoxemia exacerbates potential brain injury after deep hypothermic circulatory arrest Ann. Thorac. Surg., July 1, 2004; 78(1): 188 - 196. [Abstract] [Full Text] [PDF]

				M. J. Scallan Cerebral injury during paediatric heart surgery: perfusion issues Perfusion, July 1, 2004; 19(4): 221 - 228. [Abstract] [PDF]

				R. M. Ungerleider and J. W. Gaynor The Boston Circulatory Arrest Study: An analysis J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1256 - 1261. [Full Text] [PDF]

				R. J. Myung, P. M. Kirshbom, M. Petko, J. A. Golden, A. R. Judkins, R. F. Ittenbach, T. L. Spray, and J. W. Gaynor Modified ultrafiltration may not improve neurologic outcome following deep hypothermic circulatory arrest Eur J Cardiothorac Surg, August 1, 2003; 24(2): 243 - 248. [Abstract] [Full Text] [PDF]

				R. Pretre and M. I. Turina Deep Hypothermic Circulatory Arrest Card. Surg. Adult, January 1, 2003; 2(2003): 401 - 412. [Full Text]

				D. Spielvogel, M. N. Mathur, and R. B. Griepp Aneurysms of the Aortic Arch Card. Surg. Adult, January 1, 2003; 2(2003): 1149 - 1168. [Full Text]

				S. M. Langley, P. J. Chai, S. E. Miller, J. R. Mault, J. J. Jaggers, S. S. Tsui, A. J. Lodge, A. Lefurgey, and R. M. Ungerleider Intermittent perfusion protects the brain during deep hypothermic circulatory arrest Ann. Thorac. Surg., July 1, 1999; 68(1): 4 - 12. [Abstract] [Full Text] [PDF]

				R. M. Ungerleider Effects of Cardiopulmonary Bypass and Use of Modified Ultrafiltration Ann. Thorac. Surg., June 1, 1998; 65(90060): S35 - 39. [Abstract] [Full Text] [PDF]

				L. C. Wagerle, P. Russo, N. S. Dahdah, N. Kapadia, and D. A. Davis Endothelial dysfunction in cerebral microcirculation duringhypothermic cardiopulmonary bypass in newborn lambs J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1047 - 1051. [Abstract] [Full Text] [PDF]

				P. J. del Nido Myocardial Protection and Cardiopulmonary Bypass in Neonates and Infants Ann. Thorac. Surg., September 1, 1997; 64(3): 878 - 879. [Full Text]

				A. J. Lodge, A. Undar, C. W. Daggett, T. M. Runge, J. H. Calhoon, and R. M. Ungerleider Regional Blood Flow During Pulsatile Cardiopulmonary Bypass and After Circulatory Arrest in an Infant Model Ann. Thorac. Surg., May 1, 1997; 63(5): 1243 - 1250. [Abstract] [Full Text]

				S. S. L. Tsui, P. M. Kirshbom, M. J. Davies, M. T. Jacobs, W. J. Greeley, F. H. Kern, J. W. Gaynor, and R. M. Ungerleider Nitric Oxide Production Affects Cerebral Perfusion and Metabolism After Deep Hypothermic Circulatory Arrest Ann. Thorac. Surg., June 1, 1996; 61(6): 1699 - 1707. [Abstract] [Full Text]

				L. A. Skaryak, P. J. Chai, F. H. Kern, W. J. Greeley, and R. M. Ungerleider BLOOD GAS MANAGEMENT AND DEGREE OF COOLING: EFFECTS ON CEREBRAL METABOLISM BEFORE AND AFTER CIRCULATORY ARREST J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1649 - 1657. [Abstract] [Full Text]

				P. M. Kirshbom, L. A. Skaryak, L. R. DiBernardo, F. H. Kern, W. J. Greeley, J. W. Gaynor, and R. M. Ungerleider Effects of Aortopulmonary Collaterals on Cerebral Cooling and Cerebral Metabolic Recovery After Circulatory Arrest Circulation, November 1, 1995; 92(9): 490 - 494. [Abstract] [Full Text]

				C. L. Filgueiras, B. Winsborrow, J. Ye, J. Scott, A. Aronov, P. Kozlowski, L. Shabnavard, R. Summers, J. K. Saunders, R. Deslauriers, et al. A 31P-magnetic resonance study of antegrade and retrograde cerebral perfusion during aortic arch surgery in pigs J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 55 - 62. [Abstract] [Full Text]

				S. Buket, A. Alayunt, B. Discigil, A. Apaydin, M. Yuksel, and I. Durmaz Ege Continuous retrograde cerebral perfusion supplies substrates for brain metabolism during hypothermic circulatory arrest Perfusion, July 1, 1995; 10(4): 237 - 244. [Abstract] [PDF]

				N. Yoshimura, M. Okada, T. Ota, and H. Nohara Pharmacologic intervention for ischemic brain edema after retrograde cerebral perfusion J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1173 - 1181. [Abstract] [Full Text]

				H. J. Safi, D. C. Iliopoulos, S. P. Gopinath, K. R. Hess, P. J. Asimacopoulos, S. Bartoli, S. A. Raskin, A. T. Shaibani, C. M. Leveque, and D. H. Yawn Retrograde cerebral perfusion during profound hypothermia and circulatory arrest in pigs Ann. Thorac. Surg., May 1, 1995; 59(5): 1107 - 1112. [Abstract] [PDF]

				J. van der Linden Cerebral hemodynamics after low-flow versus no-flow procedures Ann. Thorac. Surg., May 1, 1995; 59(5): 1321 - 1325. [Abstract] [PDF]

				L. A. Skaryak, P. M. Kirshbom, L. R. DiBernardo, F. H. Kern, W. J. Greeley, R. M. Ungerleider, J. W. Gaynor, and S. b. D. C. Sabiston Jr. Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 744 - 752. [Abstract] [Full Text]

				P. J. Lin, C.-H. Chang, P. P. C. Tan, C.-C. Wang, J.-P. Chang, D.-W. Liu, J.-J. Chu, K.-T. Tsai, C.-L. Kao, and M.-J. Hsieh Protection of the brain by retrograde cerebral perfusion during circulatory arrest J. Thorac. Cardiovasc. Surg., November 1, 1994; 108(5): 969 - 974. [Abstract] [Full Text]

				J. S. Coselli Retrograde cerebral perfusion via a superior vena caval cannula for aortic arch aneurysm operations Ann. Thorac. Surg., June 1, 1994; 57(6): 1668 - 1669. [Abstract] [PDF]

				R. M. Ungerleider Direct-vision aortic valvotomy: Predecessor to modern aortic surgery Ann. Thorac. Surg., May 1, 1994; 57(5): 1351 - 1353. [Abstract] [PDF]

				C. K. Mezrow, P. S. Midulla, A. M. Sadeghi, A. Gandsas, W. Wang, O. E. Dapunt, R. Zappulla, and R. B. Griepp Evaluation of cerebral metabolism and quantitative electroencephalography after hypothermic circulatory arrest and low-flow cardiopulmonary bypass at different temperatures J. Thorac. Cardiovasc. Surg., April 1, 1994; 107(4): 1006 - 1019. [Abstract] [Full Text]

				J. R. Mault, E. G. Whitaker, J. S. Heinle, A. J. Lodge, W. J. Greeley, and R. M. Ungerleider Cerebral metabolic effects of sequential periods of hypothermic circulatory arrest Ann. Thorac. Surg., January 1, 1994; 57(1): 96 - 101. [Abstract] [PDF]

				F. A. Burrows Transcranial Doppler monitoring of cerebral perfusion during cardiopulmonary bypass Ann. Thorac. Surg., December 1, 1993; 56(6): 000349759390735Z - 349759390735Z. [Abstract] [PDF]