Cardiac output augmentation during hypoxemia improves cerebral metabolism after hypothermic cardiopulmonary bypass

Jess M. Schultz, Tara Karamlou, Irving Shen, Ross M. Ungerleider, Antonio Corno, William Douglas, John Mayer, Marshall Jacobs, Scott M. Bradley, Christian Brizard

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6 Scopus citations

Abstract

Background. Hypothermic circulatory arrest (HCA) impairs cerebral oxygen delivery (CDO2) and cerebral oxygen consumption (CMRO2), which are further reduced by perioperative hypoxemia. This study investigates if continuous hypothermic low-flow cardiopulmonary bypass (HLF) or intermittent hypothermic low-flow cardiopulmonary bypass (IHLF) can prevent reductions in CDO2 and CMRO2 during hypoxemia. Methods. Eighteen neonatal piglets, cooled to 16° to 18°C with cardiopulmonary bypass (CPB), were randomly assigned into three groups: HCA, HLF (50 cc·kg -1·min-1), or IHLF (1 minute of HLF for every 15 minutes of HCA). After 60 minutes of hypothermia, normothermic CPB (100 cc·kg-1·min-1) was established and cerebral perfusion data measured at hyperoxemia (PaO2 150 to 250 mm Hg), hypoxemia (PaO2 50 to 60 mm Hg), and severe hypoxemia (PaO 2 30 to 40 mm Hg), and with increased CPB flow (200 cc·kg -1·min-1) during severe hypoxemia. Results. The CMRO2 (in mL O2·100 g-1·min -1) was lower after HCA (2.5 ± 0.3), compared with HLF (4.1 ± 0.5, p = 0.02) and IHLF (6.2 ± 0.8, p = 0.002). Within groups, the change from hyperoxemia to severe hypoxemia resulted in decreased CMRO 2: HCA (1.3 ± 0.2, p = 0.004), HLF (3.0 ± 0.5, p = 0.01), and IHLF (2.9 ± 0.5, p = 0.01). During severe hypoxemia, increasing CPB flow (from 100 cc·kg-1·min-1 to 200 cc·kg-1·min-1) improved CMRO 2: HCA (1.9 ± 0.5, p = 0.05), HLF (4.2 ± 0.5, p = 0.05), and IHLF (7.4 ± 0.5, p = 0.04). Conclusions. Hypoxemia reduces CDO2 and CMRO2 despite the method of hypothermic CPB. Increased CPB flow during hypoxemia can restore both CDO2 and CMRO2 to values found with hyperoxemia and slower CPB flows. Augmenting cardiac output during periods of perioperative hypoxemia may prevent cerebral injury after exposure to hypothermic cardiopulmonary bypass.

Original languageEnglish (US)
Pages (from-to)625-633
Number of pages9
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 1 2006

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Schultz, J. M., Karamlou, T., Shen, I., Ungerleider, R. M., Corno, A., Douglas, W., Mayer, J., Jacobs, M., Bradley, S. M., & Brizard, C. (2006). Cardiac output augmentation during hypoxemia improves cerebral metabolism after hypothermic cardiopulmonary bypass. Annals of Thoracic Surgery, 81(2), 625-633. https://doi.org/10.1016/j.athoracsur.2005.06.042