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): Georg Nollert Dominique Shum-Tim Richard A. Jonas Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shin’oka, T. Articles by Jonas, R. A. Search for Related Content PubMed PubMed Citation Articles by Shin’oka, T. Articles by Jonas, R. A.

Ann Thorac Surg 2000;69:578-583
© 2000 The Society of Thoracic Surgeons

---

Original Articles

Utility of near-infrared spectroscopic measurements during deep hypothermic circulatory arrest

^a Department of Cardiovascular Surgery, Children’s Hospital, Boston, Massachusetts, USA
^b Department of Neurology, Children’s Hospital, Boston, Massachusetts, USA
^c Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
^d Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA

Address reprint requests to Dr Jonas, Department of Cardiovascular Surgery, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
e-mail: jonas_r{at}al.tch.harvard.edu

Background. Near-infrared spectroscopy (NIRS) is used to monitor cerebral oxygenation during cardiac surgery. However, interpretation of the signals is controversial. The aim of the study was to determine which NIRS variable best correlated with brain damage as assessed by animal behavior and neurohistologic score and to compare the accuracy of NIRS and magnetic resonance spectroscopy (MRS) in predicting brain injury.

Methods. Forty 5-week-old piglets underwent 60 minutes of deep hypothermic circulatory arrest (DHCA) at 15°C. Changes in brain adenosine triphosphate (ATP), phosphocreatine (PCr), and intracellular pH (pHi) were determined by MRS and correlated to changes in oxygenated hemoglobin (HbO₂), deoxygenated hemoglobin (Hb), and oxidized cytochrome a,a₃ (CytOx) NIRS signals. Brains were fixed on day 4 and examined using a neurohistologic score.

Results. Reductions in CytOx and HbO₂ values were correlated closely with decreases in ATP, PCr, and pHi. The changes in CytOx and PCr showed the strongest correlation (r = 0.623). Maximal CytOx reduction during DHCA of more than -25 µM * differential pathlength factor (DPF) predicted brain damage with a sensitivity of 100% and a specificity of 75%. The histologic score was also correlated with a decrease in ATP (r = -0.52 for CytOx; r = -0.32 for ATP); HbO₂, PCr, and pHi showed no correlations.

Conclusions. Reduction in CytOx correlates with decreased brain energy state and predicts histologic brain injury after DHCA with a high sensitivity. These data suggest that the level of CytOx could be a very important predictor of brain damage during DHCA.

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]

				S. D. Markowitz, R. N. Ichord, G. Wernovsky, J. W. Gaynor, and S. C. Nicolson Surrogate markers for neurological outcome in children after deep hypothermic circulatory arrest. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 59 - 65. [Abstract] [PDF]

				K. Yoshitani, M. Kawaguchi, T. Okuno, T. Kanoda, Y. Ohnishi, M. Kuro, and M. Nishizawa Measurements of Optical Pathlength Using Phase-Resolved Spectroscopy in Patients Undergoing Cardiopulmonary Bypass Anesth. Analg., February 1, 2007; 104(2): 341 - 346. [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]

				C. Olsson and S. Thelin Regional cerebral saturation monitoring with near-infrared spectroscopy during selective antegrade cerebral perfusion: Diagnostic performance and relationship to postoperative stroke J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 371 - 379. [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]

				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]

				D. Shum-Tim, C. I. Tchervenkov, A.-M. Jamal, T. Nimeh, C.-Y. Luo, E. Chedrawy, E. Laliberte, A. Philip, C. P. Rose, and J. Lavoie Systemic steroid pretreatment improves cerebral protection after circulatory arrest Ann. Thorac. Surg., November 1, 2001; 72(5): 1465 - 1472. [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]