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

This Article Full Text Full Text (PDF) 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): R. Keith Warrian Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mutch, W. A. C. Articles by Warrian, R. K. Search for Related Content PubMed PubMed Citation Articles by Mutch, W. A. C. Articles by Warrian, R. K.

Ann Thorac Surg 1998;65:59-65
© 1998 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Computer-Controlled Cardiopulmonary Bypass Increases Jugular Venous Oxygen Saturation During Rewarming

Department of Anesthesia, University of Manitoba, Winnipeg, Canada
Department of Surgery, University of Manitoba, Winnipeg, Canada

Accepted for publication June 25, 1997.

Dr Mutch, Department of Anesthesia, St. Boniface General Hospital, 409 Tache Ave, Winnipeg, Manitoba, Canada R2H 2A6 (e-mail: mutch@bldghsc.lan1.umanitoba.ca).

Background. Conventional roller pump apulsatile cardiopulmonary bypass (CPB) was compared with computer-controlled pulsatile bypass, which was designed to recreate biological variability (return of beat-to-beat variability in rate and pressure with superimposed respiratory rhythms). The degree of jugular venous oxygen saturation (SjvO₂) less than 50% during rewarming from hypothermic CPB was compared for the two bypass techniques. An SjvO₂ less than 50% during rewarming from hypothermic CPB is correlated with cognitive dysfunction in humans.

Methods. Pigs were placed on CPB for 3 hours using a membrane oxygenator with alpha-stat acid-base management and arterial filtration. After baseline measurements and normothermic CPB, the animals were randomized to apulsatile CPB (n = 12) or computer-controlled pulsatile CPB (roller pump speed adjusted by an average of 2.9 voltage output modulations/s; n = 12). The animals were then cooled to a nasopharyngeal temperature of 28°C. During rewarming to stable normothermic temperatures, SjvO₂ was measured at 5-minute intervals. The mean and cumulative areas for an SjvO₂ less than 50% were determined for all animals.

Results. No between-group differences in temperature were noted during hypothermic CPB or during rewarming. The rate of rewarming was not different between groups. Mean arterial pressure, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood also did not differ between groups. The hemoglobin concentration was within 0.4 g/dL between groups at all time periods. Mean pulse pressure was 10.0 ± 4.8 mm Hg in the apulsatile CPB group and 20.7 ± 5.2 mm Hg in the pulsatile CPB group (p = 0.0002; unpaired t test). Markedly greater mean and cumulative areas under the curve for SjvO₂ less than 50% were seen with apulsatile CPB (164 ± 209 versus 1.9 ± 3.6% · min, p = 0.021; and 1,796 ± 2,263 versus 23 ± 45% · min, p = 0.020, respectively).

Conclusions. Computer-controlled pulsatile CPB was associated with significantly greater SjvO₂ during rewarming from hypothermic CPB. Both the mean and cumulative areas under the curve for SjvO₂ less than 50% exceeded a ratio of 75:1 for apulsatile versus computer-controlled pulsatile CPB. These experiments suggest that cerebral oxygenation was better preserved during rewarming from moderate hypothermia with computer-controlled pulsatile CPB, which returned biologic variability to the flow pattern.

This article has been cited by other articles:

				R. K. Singal, L. M. Docking, L. G. Girling, M. R. Graham, P. W. Nickerson, B. M. McManus, A. B. Magil, E. K.-Y. Walker, R. K. Warrian, M. S. Cheang, et al. Biologically variable bypass reduces enzymuria after deep hypothermic circulatory arrest. Ann. Thorac. Surg., October 1, 2006; 82(4): 1480 - 1488. [Abstract] [Full Text] [PDF]

				C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]

				H. T. Kiziltan, M. Baltali, A. Bilen, G. Seydaoglu, M. Incesoz, A. Tasdelen, and S. Aslamaci Comparison of Alpha-Stat and pH-Stat Cardiopulmonary Bypass in Relation to Jugular Venous Oxygen Saturation and Cerebral Glucose-Oxygen Utilization Anesth. Analg., March 1, 2003; 96(3): 644 - 650. [Abstract] [Full Text] [PDF]

				A. BOKER, M. RUTH GRAHAM, K. R. WALLEY, B. M. MCMANUS, L. G. GIRLING, E. WALKER, G. R. LEFEVRE, and W.A. C. MUTCH Improved Arterial Oxygenation with Biologically Variable or Fractal Ventilation Using Low Tidal Volumes in a Porcine Model of Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., February 15, 2002; 165(4): 456 - 462. [Abstract] [Full Text] [PDF]

				M. R. Graham, R. K. Warrian, L. G. Girling, L. Doiron, G. R. Lefevre, M. Cheang, and W. A. C. Mutch Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 63 - 71. [Abstract] [Full Text] [PDF]

				R. Svedjeholm, E. Hakanson, Z. Szabo, and F. Vanky Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 611 - 618. [Abstract] [Full Text] [PDF]

				F. A. Pigula, R. D. Siewers, and E. M. Nemoto Hypothermic cardiopulmonary bypass alters oxygen/glucose uptake in the pediatric brain J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0366 - 373. [Abstract] [Full Text] [PDF]

				W. A. C.  MUTCH, S. HARMS, M. RUTH GRAHAM, S. E. KOWALSKI, L. G. GIRLING, and G. R. LEFEVRE Biologically Variable or Naturally Noisy Mechanical Ventilation Recruits Atelectatic Lung Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 319 - 323. [Abstract] [Full Text]

				W. A. C. Mutch, R. K. Warrian, G. M. Eschun, L. G. Girling, L. Doiron, M. S. Cheang, and G. R. Lefevre Biologically variable pulsation improves jugular venous oxygen saturation during rewarming Ann. Thorac. Surg., February 1, 2000; 69(2): 491 - 497. [Abstract] [Full Text] [PDF]

				F. Kawahara, Y. Kadoi, S. Saito, D. Yoshikawa, F. Goto, and N. Fujita BALLOON PUMP-INDUCED PULSATILE PERFUSION DURING CARDIOPULMONARY BYPASS DOES NOT IMPROVE BRAIN OXYGENATION J. Thorac. Cardiovasc. Surg., August 1, 1999; 118(2): 361 - 366. [Abstract] [Full Text] [PDF]