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Cerebral metabolism during deep hypothermic circulatory arrest vs moderate hypothermic selective cerebral perfusion in a piglet model: a microdialysis study. 2009

Erol Cavus, and Grischa Hoffmann, and Berthold Bein, and Jens Scheewe, and Patrick Meybohm, and Jochen Renner, and Jens Scholz, and Andreas Boening
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel 24105, Germany. e.cavus@t-online.de

BACKGROUND Few data exist regarding antegrade selective cerebral perfusion (ASCP) and its application in newborn and juvenile patients. Clinical data suggest ASCP alone to be superior to deep hypothermic circulatory arrest (DHCA); however, the effects of moderate hypothermia during ASCP on cerebral metabolism in this patient population are still unclear. METHODS After obtaining the approval from animal investigation committee, 16 piglets were randomly assigned to circulatory arrest combined with either ASCP at 27 degrees C or DHCA at 18 degrees C for 90 min. Cerebral oxygen extraction fraction (COEF) from blood as well as cerebral tissue glucose, glycerol, lactate, pyruvate, and the lactate/pyruvate ratio (L/P ratio) by microdialysis were obtained repeatedly. RESULTS COEF was lower during cooling and rewarming, respectively, in the DHCA18 group compared to the ASCP27 group (30 +/- 8 vs 56 +/- 13% and 35 +/- 6 vs 58 +/- 7%, respectively). Glucose decreased in both the DHCA18 and ASCP27 groups during the course of cardiopulmonary bypass (CPB), but were higher in the ASCP27 group during ASCP, compared to the DHCA18 group during circulatory arrest (0.7 +/- 0.1 vs 0.2 +/- 0.1 mm.l(-1), P < 0.05). Pyruvate was higher (ASCP27 vs DHCA18: 53 +/- 17 vs 6 +/- 2 microm.l(-1), P < 0.05), and the L/P ratio increased during circulatory arrest in the DHCA18 group, compared to the selective perfusion phase of the ASCP27 group (DHCA18 vs ASCP27: 1891 +/- 1020 vs 70 +/- 28, P < 0.01). CONCLUSIONS In this piglet model, both cerebral oxygenation and microdialysis findings suggested a depletion of cerebral energy stores during circulatory arrest in the DHCA18 group, compared to selective cerebral perfusion combined with circulatory arrest in the ASCP27 group.

UI MeSH Term Description Entries
D008297 Male Males
D010100 Oxygen An element with atomic symbol O, atomic number 8, and atomic weight [15.99903; 15.99977]. It is the most abundant element on earth and essential for respiration. Dioxygen,Oxygen-16,Oxygen 16
D010313 Partial Pressure The pressure that would be exerted by one component of a mixture of gases if it were present alone in a container. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Partial Pressures,Pressure, Partial,Pressures, Partial
D011897 Random Allocation A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. Randomization,Allocation, Random
D001921 Brain The part of CENTRAL NERVOUS SYSTEM that is contained within the skull (CRANIUM). Arising from the NEURAL TUBE, the embryonic brain is comprised of three major parts including PROSENCEPHALON (the forebrain); MESENCEPHALON (the midbrain); and RHOMBENCEPHALON (the hindbrain). The developed brain consists of CEREBRUM; CEREBELLUM; and other structures in the BRAIN STEM. Encephalon
D002548 Cerebral Revascularization Microsurgical revascularization to improve intracranial circulation. It usually involves joining the extracranial circulation to the intracranial circulation but may include extracranial revascularization (e.g., subclavian-vertebral artery bypass, subclavian-external carotid artery bypass). It is performed by joining two arteries (direct anastomosis or use of graft) or by free autologous transplantation of highly vascularized tissue to the surface of the brain. Brain Revascularization,EC-IC Arterial Bypass,Extracranial-Intracranial Arterial Bypass,Microsurgical Revascularization, Cerebral,STA-MCA Bypass,Cerebral Microsurgical Revascularization,Arterial Bypass, EC-IC,Arterial Bypass, Extracranial-Intracranial,Arterial Bypasses, EC-IC,Arterial Bypasses, Extracranial-Intracranial,Bypass, EC-IC Arterial,Bypass, Extracranial-Intracranial Arterial,Bypass, STA-MCA,Bypasses, EC-IC Arterial,Bypasses, Extracranial-Intracranial Arterial,Bypasses, STA-MCA,Cerebral Microsurgical Revascularizations,EC IC Arterial Bypass,EC-IC Arterial Bypasses,Extracranial Intracranial Arterial Bypass,Extracranial-Intracranial Arterial Bypasses,Revascularization, Brain,Revascularization, Cerebral,Revascularization, Cerebral Microsurgical,STA MCA Bypass,STA-MCA Bypasses
D004734 Energy Metabolism The chemical reactions involved in the production and utilization of various forms of energy in cells. Bioenergetics,Energy Expenditure,Bioenergetic,Energy Expenditures,Energy Metabolisms,Expenditure, Energy,Expenditures, Energy,Metabolism, Energy,Metabolisms, Energy
D005260 Female Females
D005947 Glucose A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. Dextrose,Anhydrous Dextrose,D-Glucose,Glucose Monohydrate,Glucose, (DL)-Isomer,Glucose, (alpha-D)-Isomer,Glucose, (beta-D)-Isomer,D Glucose,Dextrose, Anhydrous,Monohydrate, Glucose
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia

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