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Ann Thorac Surg 2003;76:1215-1226
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

pH-stat versus alpha-stat perfusion strategy during experimental hypothermic circulatory arrest: a microdialysis study

Matti Pokela, MDa, Sebastian Dahlbacka, MSa, Fausto Biancari, MD, PhDa, Vilho Vainionpää, MD, PhDb, Timo Salomäki, MD, PhDb, Kai Kiviluoma, MD, PhDb, Erkka Rönkä, MSa, Timo Kaakinen, MSa, Janne Heikkinen, MSa, Jorma Hirvonen, MD, PhDc, Pekka Romsi, MDa, Vesa Anttila, MD, PhDa, Tatu Juvonen, MD, PhDa*

a Department of Surgery, , Oulu, Finland
b Department of Anesthesiology, Oulu, Finland
c Department of Forensic Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland

* Address reprint requests to Prof Juvonen, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, PO Box 21, 90029 Oulu OYS, Finland.
e-mail: tatu.juvonen{at}oulu.fi

Presented at the Poster Session of the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: The superiority of the pH-stat to the {alpha}-stat acid-base strategy during cardiopulmonary bypass as a neuroprotective method during hypothermic circulatory arrest is still controversial. In the present study, brain metabolism and outcome have been evaluated in a surviving model of experimental hypothermic circulatory arrest.

METHODS: Twenty pigs undergoing 75-minutes of hypothermic circulatory arrest at a brain temperature of 18°C were randomly assigned to the {alpha}-stat (n = 10) or pH-stat (n = 10) strategy during cardiopulmonary bypass.

RESULTS: The 7-day survival rate was 90% (9 of 10) in the pH-stat group and 10% (1 of 10) in the {alpha}-stat group. At the end of cooling, pH-stat strategy was associated with significantly lower brain lactate and pyruvate concentrations and brain lactate-glucose ratio. After reperfusion, brain concentrations of glycerol, lactate, pyruvate, and lactate-glucose ratio were significantly lower in the pH-stat group. This strategy was associated with a faster rise of brain tissue temperature and reoxygenation on reperfusion, which is likely secondary to improved cerebral perfusion.

CONCLUSIONS: During cardiopulmonary bypass before and after a period of hypothermic circulatory arrest, acid-base management according to the pH-stat principles seemed to be associated with less derangements in cerebral metabolism, lower intracranial pressures, and excellent behavioral recovery and survival outcome. Because there is strong evidence of the beneficial metabolic effects related to this method, further studies using an experimental model of combined HCA and embolic brain injury are required to exclude a possible increased risk of cerebral embolism associated with the pH-stat strategy.




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