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Ann Thorac Surg 2000;69:420
© 2000 The Society of Thoracic Surgeons

Invited Commentaries

Keith J. Ruskin, MDa

a Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St, PO Box 208051, New Haven, CT 06520-8051, USA

Invited commentary

In this study, Cook and coworkers explore the effects of core temperature and PaCO2 on cerebral embolization of polystyrene microspheres during cardiopulmonary bypass. The authors performed this study to determine if simple physiologic interventions (essentially moderate hypothermia and {alpha}-stat management instead of pH-stat management) can decrease the incidence of neurologic injury. If the results of this paper can be reproduced, and are applicable in humans, a significant improvement in morbidity might result from a small change in patient management during periods of embolic risk.

The study does have some minor problems that will have to be resolved with additional research. The authors do not control cardiopulmonary bypass flow rates between normothermic and hypothermic groups. Differ-ences in flow rates could possibly affect the amount of cerebral embolization that occurred during the study. The use of historical controls is another potential problem. Of course, the results in this study must be verified in both animal studies and controlled human trials before making changes in treatment. Despite these issues, however, Cook and coworkers describe a simple physiologic intervention that may decrease the incidence of potentially devastating neurologic injury.


Related Article

Effect of temperature and PaCO2 on cerebral embolization during cardiopulmonary bypass in swine
David J. Cook, Walter Plöchl, and Thomas A. Orszulak
Ann. Thorac. Surg. 2000 69: 415-420. [Abstract] [Full Text] [PDF]




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