ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Kenton J. Zehr
Anthony W. Lee
Bruce A. Reitz
William A. Baumgartner
Duke E. Cameron
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gillinov, A. M.
Right arrow Articles by Cameron, D. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gillinov, A. M.
Right arrow Articles by Cameron, D. E.

Ann Thorac Surg 1993;55:1432-1439
© 1993 The Society of Thoracic Surgeons

Articles

Superior cerebral protection with profound hypothermia during circulatory arrest

A. Marc Gillinov, MD, J. Mark Redmond, MD, Kenton J. Zehr, MD, Juan C. Troncose, MD, Santiago Arroyo, MD, Ronald P. Lesser, MD, Anthony W. Lee, MD, R. Scott Stuart, MD, Bruce A. Reitz, MD, William A. Baumgartner, MD, Duke E. Cameron, MD*

Departments of Cardia Surgery, Pathology, and Neurology, and the Zanvyl Kreiger Mind/Brain Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland USA

* Address reprint requests to Dr Cameron, The Johns Hopkins Hospital, 600 N Wolfe St. Blatock 618, Baltimore, MD 21205.

The optimal temperature for cerebral protection during hypothermic circulatory arrest is not known. This study was undertaken to test the hypothesis that deeper levels of cerebral hypothermia (< 10 °C) confer better protection against neurologic injury during prolonged hypothermic circulatory arrest ("colder is better"). Twelve male dogs (20 to 25 kg) were placed on closed-chest cardiopulmonary bypass via femoral artery and femoral/external jugular vein. Using surface and core cooling, tympanic membrane temperature was lowered to 18 ° to 20 °C (deep hypothermia, n = 6) or 5 ° to 7 °C (profound hypothermia, n = 6). After 2 hours of hypothermic circulatory arrest, animals were rewarmed to 35 ° to 37 °C on cardiopulmonary bypass. All were mechanically ventilated and monitored in an intensive care unit setting for 20 hours. Neurologic assessment was performed every 12 hours using a species-specific behavior scale that yielded a neurodeficit score ranging from 0% to 100%, where 0 = normal and 100% = brain dead. After 72 hours, animals were sacrificed and examined histoiogically for neurologic injury. Histologic injury scores were assigned to each animal (range, 0 [normal] to 100 [severe injury]). At the end of the observation period, profoundly hypothermic animals had better neurologic function (neurodeficit score, 5.7% ± 4.0%) compared with deeply hypothermic animals (neurodeficit score, 41% ± 9.3%; p < 0.006). Every animal had histologic evidence of neurologic injury, but profoundly hypothermic animals had significantly less injury (histologic injury score, 19.2 ± 1.2 versus 48.3 ± 1.5; p < 0.0001). These results demonstrate that profound cerebral hypothermia (5 ° to 7 °C) affords better neurologic protection than deep hypothermia (13 ° to 20 °C) during prolonged hypothermic circulatory arrest and suggest that special efforts to achieve profound hypothermia may be advantageous when extended periods of circulatory arrest are anticipated.




This article has been cited by other articles:


Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
M. Arrica and B. Bissonnette
Therapeutic hypothermia.
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 6 - 15.
[Abstract] [PDF]

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

Home page
 Ann. Thorac. Surg.Home page
J. A. Williams, C. J. Barreiro, L. U. Nwakanma, M. S. Lange, L. E. Kratz, M. E. Blue, J. Berrong, N. D. Patel, V. L. Gott, J. C. Troncoso, et al.
Valproic Acid Prevents Brain Injury in a Canine Model of Hypothermic Circulatory Arrest: A Promising New Approach to Neuroprotection During Cardiac Surgery
Ann. Thorac. Surg., June 1, 2006; 81(6): 2235 - 2242.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. Amir, C. Ramamoorthy, R. K. Riemer, V. M. Reddy, and F. L. Hanley
Neonatal Brain Protection and Deep Hypothermic Circulatory Arrest: Pathophysiology of Ischemic Neuronal Injury and Protective Strategies
Ann. Thorac. Surg., November 1, 2005; 80(5): 1955 - 1964.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
C. Mavroudis and R. M. Sade
The Southern Thoracic Surgical Association 50th anniversary celebration: the impact of STSA pediatric cardiothoracic surgery manuscripts on surgical practice
Ann. Thorac. Surg., November 1, 2003; 76(90050): S47 - 67.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
P. Sekaran, M. Ehrlich, C. Hagl, M. L. Leavitt, R. Jacobs, J. N. McCullough, and E. Bennett-Guerrero
A Comparison of Complete Blood Replacement With Varying Hematocrit Levels on Neurological Recovery in a Porcine Model of Profound Hypothermic (<5{degrees}C) Circulatory Arrest
Anesth. Analg., February 1, 2001; 92(2): 329 - 334.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
M. J Elliott
Recent advances in paediatric cardiopulmonary bypass
Perfusion, July 1, 1999; 14(4): 237 - 246.
[PDF]

Home page
 CirculationHome page
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]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
J. M. Murkin
The role of CPB management in neurobehavioral outcomes after cardiac surgery
Ann. Thorac. Surg., May 1, 1995; 59(5): 1308 - 1311.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
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]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
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]

Home page
 PerfusionHome page
F. Dexter, B. J Hindman, J. Cutkomp, and T. Smith
Blood warms as it flows retrograde from a femoral cannulation site to the carotid artery during cardiopulmonary bypass
Perfusion, November 1, 1994; 9(6): 393 - 397.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
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]

Home page
 Ann. Thorac. Surg.Home page
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]

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


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1993 by The Society of Thoracic Surgeons.