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Ann Thorac Surg 2006;81:183-190
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Hypertonic Saline Dextran Improves Outcome After Hypothermic Circulatory Arrest: A Study in a Surviving Porcine Model

Timo Kaakinen, MD a , Hanna Alaoja, MS a , Janne Heikkinen, MD a , Sebastian Dahlbacka, MS a , Päivi Laurila, MD, PhD b , Kai Kiviluoma, MD, PhD b , Timo Salomäki, MD, PhD b , Hannu Tuominen, MD, PhD c , Pasi Ohtonen, MS a , b , Fausto Biancari, MD, PhD a , Tatu Juvonen, MD, PhD a , *

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

Accepted for publication July 5, 2005.

* Address correspondence to Prof Juvonen, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, PO Box 21, 90029 OYS, Finland (Email: tatu.juvonen{at}oulu.fi).

BACKGROUND: Hypertonic saline dextran (HSD) has been shown to have neuroprotective properties. In the present study we have assessed its potential neuroprotective efficacy in the setting of hypothermic circulatory arrest in a surviving porcine model.

METHODS: Twenty-four pigs were randomized to receive two 5-minute intravenous infusions (4 mL/kg) of either HSD (7.5 % saline, 6% dextran 70) or normal saline immediately after and 4 hours after a 75-minute period of hypothermic circulatory arrest at a brain temperature of 18°C.

RESULTS: The 7-day survival was 75% in the HSD group and 66% in the control group (p > 0.9). Brain total histopathologic score was lower in the HSD group (p = 0.01). Postoperative behavioral scores were higher in the HSD group on the second day after surgery (p = 0.03). Intracranial pressure was lower in the HSD group from 45 minutes to 8 hours after hypothermic circulatory arrest (p = 0.03). Cerebral perfusion pressure was higher in the HSD group from 45 minutes to 3 hours after hypothermic circulatory arrest (p = 0.06). Brain lactate concentration was lower in the HSD group when compared with controls (p = 0.05). Furthermore, brain glucose levels tended to be higher and brain lactate-pyruvate ratio and lactate-glucose ratio were lower in the HSD group. Brain tissue oxygen partial pressures were somewhat higher in the HSD group (p = 0.08).

CONCLUSIONS: The use of HSD in experimental hypothermic circulatory arrest is associated with significantly better neurologic recovery, better histopathology, lower intracranial pressure, higher cerebral perfusion pressure, and better preservation of brain metabolism.




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M. Stecker
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Ann. Thorac. Surg., January 1, 2006; 81(1): 190 - 190.
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