| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;65:155-164
© 1998 The Society of Thoracic Surgeons
Department of Cardiovascular Surgery, Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,
Department of Anesthesia and Intensive Care, Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,
Department of Pathology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Department of Neurology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Dr Jonas, Department of Cardiovascular Surgery, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115.
Presented at the Poster Session of the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
Background. A recent study found that a higher-perfusate hematocrit was associated with improved neurologic recovery after deep hypothermic circulatory arrest. The current study examined the relative contributions of oxygen delivery and colloid oncotic pressure to this result, as well as the efficacy of different colloidal agents and modified ultrafiltration.
Methods. Twenty-six piglets were randomized into five groups (n = 5 or 6 animals per group): control group 1—blood and crystalloid prime, hematocrit of 20%; group 2—blood and hetastarch prime, hematocrit of 20%; group 3—blood and pentafraction prime, hematocrit of 20%; group 4—blood and crystalloid prime with 10 minutes of modified ultrafiltration; group 5—whole blood prime, hematocrit of 30%. All groups underwent 60 minutes of deep hypothermic circulatory arrest at 15°C.
Results. Groups 2 and 3 showed less body weight gain (analysis of variance, p = 0.001; group 2 versus group 1, p = 0.0009; group 3 versus group 1, p = 0.0009) and body water content after cardiopulmonary bypass (analysis of variance, p = 0.001; group 2 versus group 1, p = 0.003; group 3 versus group 1, p = 0.013). Group 5 showed more rapid recovery of phosphocreatine and intracellular acidosis, as measured by magnetic resonance spectroscopy, during rewarming than group 1 did (phosphocreatine, p = 0.0329; intracellular acidosis, p = 0.0462). Group 3 also showed accelerated recovery of intracellular acidosis (p = 0.0411). Cytochrome a,a3 recovery, determined by near-infrared spectroscopy, was significantly better in group 5 than in group 1 and worse in group 2 than in group 1 after rewarming. The neurologic deficit score and overall performance category score were best in group 5 (neurologic deficit score, p = 0.012; overall performance category score, p = 0.046) on the first postoperative day. Group 3 also had a better overall performance category score than group 1 did (p = 0.0068). Only group 1 and 2 animals showed histologic damage.
Conclusions. Both higher hematocrit and higher colloid oncotic pressure with pentafraction improve cerebral recovery after deep hypothermic circulatory arrest. The higher hematocrit improves cerebral oxygen delivery but does not reduce total body edema. Modified ultrafiltration after cardiopulmonary bypass is less effective than having a higher initial prime hematocrit or colloid oncotic pressure.
This article has been cited by other articles:
|
|
 |
|
  E Hirleman and D. Larson Cardiopulmonary bypass and edema: physiology and pathophysiology Perfusion, November 1, 2008; 23(6): 311 - 322. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Loeffelbein, U. Zirell, C. Benk, C. Schlensak, and S. Dittrich High colloid oncotic pressure priming of cardiopulmonary bypass in neonates and infants: implications on haemofiltration, weight gain and renal function Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 648 - 652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Wypij, R. A. Jonas, D. C. Bellinger, P. J. Del Nido, J. E. Mayer Jr., E. A. Bacha, J. M. Forbess, F. Pigula, P. C. Laussen, and J. W. Newburger The effect of hematocrit during hypothermic cardiopulmonary bypass in infant heart surgery: results from the combined Boston hematocrit trials. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 355 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Lawson, G. Smigla, C. McRobb, R Walczak, D Kaemmer, I. Shearer, A Lodge, and J Jaggers A clinical evaluation of the Dideco Kids D100 neonatal oxygenatora Perfusion, January 1, 2008; 23(1): 39 - 42. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Pretre and M. I. Turina Deep Hypothermic Circulatory Arrest Card. Surg. Adult, January 1, 2008; 3(2008): 431 - 442. [Full Text]
|
|
|
|
|
|
J. C. Halstead, M. Wurm, D. M. Meier, N. Zhang, D. Spielvogel, D. Weisz, C. Bodian, and R. B. Griepp Avoidance of hemodilution during selective cerebral perfusion enhances neurobehavioral outcome in a survival porcine model Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 514 - 520. [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]
|
|
|
|
|
|
W. M Medlin and J. J Sistino Cerebral oxygen saturation changes during modified ultrafiltration Perfusion, November 1, 2006; 21(6): 325 - 328. [Abstract] [PDF]
|
|
|
|
 |
|
 L. J. Woodward, P. J. Anderson, N. C. Austin, K. Howard, and T. E. Inder Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants. N. Engl. J. Med., August 17, 2006; 355(7): 685 - 694. [Abstract] [Full Text] [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]
|
|
|
|
|
|
K. Karkouti, G. Djaiani, M. A. Borger, W. S. Beattie, L. Fedorko, D. Wijeysundera, J. Ivanov, and J. Karski Low Hematocrit During Cardiopulmonary Bypass is Associated With Increased Risk of Perioperative Stroke in Cardiac Surgery Ann. Thorac. Surg., October 1, 2005; 80(4): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. W. Loepke, J. A. Golden, J. C. McCann, and C. D. Kurth Injury Pattern of the Neonatal Brain After Hypothermic Low-Flow Cardiopulmonary Bypass in a Piglet Model Anesth. Analg., August 1, 2005; 101(2): 340 - 348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sakamoto, D. Zurakowski, L. F. Duebener, H. G. W. Lidov, G. L. Holmes, R. J. Hurley, P. C. Laussen, and R. A. Jonas Interaction of temperature with hematocrit level and pH determines safe duration of hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 220 - 232. [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]
|
|
|
|
|
|
G. Pardi, M. M. Ferrari, F. Iorio, F. Acocella, V. Boero, N. Berlanda, A. Monaco, C. Reato, F. Santoro, and I. Cetin The effect of maternal hypothermic cardiopulmonary bypass on fetal lamb temperature, hemodynamics, oxygenation, and acid-base balance J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1728 - 1734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sakamoto, G. D. A. Nollert, D. Zurakowski, J. Soul, L. F. Duebener, J. Sperling, M. Nagashima, G. Taylor, A. J. duPlessis, and R. A. Jonas Hemodilution elevates cerebral blood flow and oxygen metabolism during cardiopulmonary bypass in piglets Ann. Thorac. Surg., May 1, 2004; 77(5): 1656 - 1663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: Should current practice be changed? J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1438 - 1450. [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]
|
|
|
|
|
|
J. M. Forbess, K. J. Visconti, D. C. Bellinger, R. J. Howe, and R. A. Jonas Neurodevelopmental outcomes after biventricular repair of congenital heart defects J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 631 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sakamoto, D. Zurakowski, L. F. Duebener, S.'i. Hatsuoka, H. G.W. Lidov, G. L. Holmes, U. A. Stock, P. C. Laussen, and R. A. Jonas Combination of alpha-stat strategy and hemodilution exacerbates neurologic injury in a survival piglet model with deep hypothermic circulatory arrest Ann. Thorac. Surg., January 1, 2002; 73(1): 180 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Duebener, T. Sakamoto, S.-i. Hatsuoka, C. Stamm, D. Zurakowski, B. Vollmar, M. D. Menger, H.-J. Schafers, and R. A. Jonas Effects of Hematocrit on Cerebral Microcirculation and Tissue Oxygenation During Deep Hypothermic Bypass Circulation, September 18, 2001; 104 (2009): I-260 - I-264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sakamoto, S.'i. Hatsuoka, U. A. Stock, L. F. Duebener, H. G. W. Lidov, G. L. Holmes, J. S. Sperling, M. Munakata, P. C. Laussen, and R. A. Jonas Prediction of safe duration of hypothermic circulatory arrest by near-infrared spectroscopy J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 339 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, N. A. Tatton, D. J. Weisz, N. Zhang, D. Spielvogel, H. H. Shiang, C. A. Bodian, and R. B. Griepp Cyclosporine A as a potential neuroprotective agent: a study of prolonged hypothermic circulatory arrest in a chronic porcine model Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 756 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Simonardottir, B. Torfason, and J. Magnusson Is compartment pressure related to plasma colloid osmotic pressure, in patients during and after cardiac surgery? Perfusion, March 1, 2001; 16(2): 137 - 145. [Abstract] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
J. M. Pearl, D. W. Thomas, G. Grist, J. Y. Duffy, and P. B. Manning Hyperoxia for management of acid-base status during deep hypothermia with circulatory arrest Ann. Thorac. Surg., September 1, 2000; 70(3): 751 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Codispoti and P. S Mankad Management of anticoagulation and its reversal during paediatric cardiopulmonary bypass: a review of current UK practice Perfusion, May 1, 2000; 15(3): 191 - 201. [Abstract] [PDF]
|
|
|
|
 |
|
 C. S. Cox Jr., M. Brennan, and S. J. Allen Impact of hetastarch on the intestinal microvascular barrier during ECLS J Appl Physiol, April 1, 2000; 88(4): 1374 - 1380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Shin’oka, G. Nollert, D. Shum-Tim, A. du Plessis, and R. A. Jonas Utility of near-infrared spectroscopic measurements during deep hypothermic circulatory arrest Ann. Thorac. Surg., February 1, 2000; 69(2): 578 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Darling, S. Harris-Holloway, F. H Kern, R. Ungerleider, J. Jaggers, S. Lawson, and I. Shearer Impact of modifying priming components and fluid administration using miniaturized circuitry in neonatal cardiopulmonary bypass Perfusion, January 1, 2000; 15(1): 3 - 12. [Abstract] [PDF]
|
|
|
|
|
|
R. Berryessa, R. Wiencek, J. Jacobson, D. Hollingshead, K. Farmer, and G. Cahill Practical techniques Vacuum-assisted venous return in pediatric cardiopulmonary bypass Perfusion, January 1, 2000; 15(1): 63 - 67. [Abstract] [PDF]
|
|
|
|
|
|
K. J. Visconti, D. P. Bichell, R. A. Jonas, J. W. Newburger, and D. C. Bellinger Developmental Outcome After Surgical Versus Interventional Closure of Secundum Atrial Septal Defect in Children Circulation, November 9, 1999; 100 (2009): II-145 - II-150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Gruber, R. A. Jonas, J. W. Newburger, D. Zurakowski, D. D. Hansen, and P. C. Laussen The Effect of Hematocrit on Cerebral Blood Flow Velocity in Neonates and Infants Undergoing Deep Hypothermic Cardiopulmonary Bypass Anesth. Analg., August 1, 1999; 89(2): 322 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J Elliott Recent advances in paediatric cardiopulmonary bypass Perfusion, July 1, 1999; 14(4): 237 - 246. [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 |
