C D Kurth1, M M O'Rourke, I B O'Hara. 1. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104, USA. kurth@email.chop.edu
Abstract
BACKGROUND: Deep hypothermic circulatory arrest is used in neonatal cardiac surgery. Recent work has suggested improved neurologic recovery after deep hypothermic arrest with pH-stat cardiopulmonary bypass (CPB) compared with alpha-stat CPB. This study examined cortical oxygen saturation (ScO2), cortical blood flow (CBF), and cortical physiologic recovery in relation to deep hypothermic arrest with alpha-stat or pH-stat CPB. METHODS: Sixteen piglets were cooled with pH-stat or alpha-stat CPB to 19 degrees C (cortex) and subjected to 60 min of circulatory arrest, followed by CPB reperfusion and rewarming and separation from CPB. Near infrared spectroscopy and laser Doppler flowmetry were used to monitor ScO2 and CBF. Cortical physiologic recovery was assessed 2 h after the piglets were separated from CPB by cortical adenosine triphosphate concentrations, cortical water content, CBF, and ScO2. RESULTS: During CPB cooling, ScO2 increased more with pH-stat than with alpha-stat bypass (123 +/- 33% vs. 80 +/- 25%); superficial and deep CBF were also greater with pH-stat than with alpha-stat bypass (22 +/- 25% vs. -56 +/- 22%, 3 +/- 19% vs. -29 +/- 28%). During arrest, ScO2 half-life was greater with pH-stat than with alpha-stat bypass (10 +/- 2 min vs. 7 +/- 2 min), and cortical oxygen consumption lasted longer with pH-stat than with alpha-stat bypass (36 +/- 8 min vs. 25 +/- 8 min). During CPB reperfusion, superficial and deep CBF were less with alpha-stat than with pH-stat bypass (-40 +/- 22% vs. 10 +/- 39%, -38 +/- 28% vs. 5 +/- 28%). After CPB, deep cortical adenosine triphosphate and CBF were less with alpha-stat than with pH-stat bypass (11 +/- 6 pmole/mg vs. 17 +/- 8 pmole/mg, -24 +/- 16% vs. 16 +/- 32%); cortical water content was greater with alpha-stat than with pH-stat bypass (superficial: 82.4 +/- 0.3% vs. 81.8 +/- 1%, deep: 79.1 +/- 2% vs. 78 +/- 1.6%). CONCLUSIONS: Cortical deoxygenation during hypothermic arrest was slower after pH-stat CPB. pH-stat bypass increased the prearrest ScO2 and arrest ScO2 half-life, to increase the cortical oxygen supply and slow cortical oxygen consumption. Improved cortical physiologic recovery after hypothermic arrest was suggested with pH-stat management.
BACKGROUND: Deep hypothermic circulatory arrest is used in neonatal cardiac surgery. Recent work has suggested improved neurologic recovery after deep hypothermic arrest with pH-stat cardiopulmonary bypass (CPB) compared with alpha-stat CPB. This study examined cortical oxygen saturation (ScO2), cortical blood flow (CBF), and cortical physiologic recovery in relation to deep hypothermic arrest with alpha-stat or pH-stat CPB. METHODS: Sixteen piglets were cooled with pH-stat or alpha-stat CPB to 19 degrees C (cortex) and subjected to 60 min of circulatory arrest, followed by CPB reperfusion and rewarming and separation from CPB. Near infrared spectroscopy and laser Doppler flowmetry were used to monitor ScO2 and CBF. Cortical physiologic recovery was assessed 2 h after the piglets were separated from CPB by cortical adenosine triphosphate concentrations, cortical water content, CBF, and ScO2. RESULTS: During CPB cooling, ScO2 increased more with pH-stat than with alpha-stat bypass (123 +/- 33% vs. 80 +/- 25%); superficial and deep CBF were also greater with pH-stat than with alpha-stat bypass (22 +/- 25% vs. -56 +/- 22%, 3 +/- 19% vs. -29 +/- 28%). During arrest, ScO2 half-life was greater with pH-stat than with alpha-stat bypass (10 +/- 2 min vs. 7 +/- 2 min), and cortical oxygen consumption lasted longer with pH-stat than with alpha-stat bypass (36 +/- 8 min vs. 25 +/- 8 min). During CPB reperfusion, superficial and deep CBF were less with alpha-stat than with pH-stat bypass (-40 +/- 22% vs. 10 +/- 39%, -38 +/- 28% vs. 5 +/- 28%). After CPB, deep cortical adenosine triphosphate and CBF were less with alpha-stat than with pH-stat bypass (11 +/- 6 pmole/mg vs. 17 +/- 8 pmole/mg, -24 +/- 16% vs. 16 +/- 32%); cortical water content was greater with alpha-stat than with pH-stat bypass (superficial: 82.4 +/- 0.3% vs. 81.8 +/- 1%, deep: 79.1 +/- 2% vs. 78 +/- 1.6%). CONCLUSIONS: Cortical deoxygenation during hypothermic arrest was slower after pH-stat CPB. pH-stat bypass increased the prearrest ScO2 and arrest ScO2 half-life, to increase the cortical oxygen supply and slow cortical oxygen consumption. Improved cortical physiologic recovery after hypothermic arrest was suggested with pH-stat management.
Authors: Afsaneh Pirzadeh; Gregory Schears; Peter Pastuszko; Huiping Liu; Joanna Kubin; Erin Reade; Alberto Mendoza-Paredes; William Greeley; Vinay Nadkarni; David F Wilson; Anna Pastuszko Journal: Pediatr Crit Care Med Date: 2011-03 Impact factor: 3.624
Authors: Scott D Markowitz; Alberto Mendoza-Paredes; Huiping Liu; Peter Pastuszko; Steven P Schultz; Gregory J Schears; William J Greeley; David F Wilson; Anna Pastuszko Journal: Ann Thorac Surg Date: 2007-07 Impact factor: 4.330
Authors: Aron Kerenyi; Dorottya Kelen; Stuart D Faulkner; Alan Bainbridge; Manigandan Chandrasekaran; Ernest B Cady; Xavier Golay; Nicola J Robertson Journal: Pediatr Res Date: 2012-02-07 Impact factor: 3.756
Authors: Radosław Gocoł; Damian Hudziak; Jarosław Bis; Konrad Mendrala; Łukasz Morkisz; Paweł Podsiadło; Sylweriusz Kosiński; Jacek Piątek; Tomasz Darocha Journal: Int J Environ Res Public Health Date: 2021-07-01 Impact factor: 3.390