Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-20T02:34:31.076Z Has data issue: false hasContentIssue false

Experimental studies of hypothermic circulatory arrest and low flow bypass

Published online by Cambridge University Press:  19 August 2008

Richard A. Jonas*
Affiliation:
From the Department of Cardiac Surgery, Children's Hospital, Boston
*
Dr. Richard A. Jonas, Department of Cardiac Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

Extract

Although the brain is the organ most sensitive to total bodily ischemia, and probably also most sensitive to the deleterious effects of cardiopulmonary bypass, it is also the most difficult organ in which to quantitate function accurately. Clinical studies allow sensitive neuropsychometric testing, as discussed elsewhere in this issue (see Wernovsky et al, p. 308). This is not possible in studies using animals. Even testing of gross neurological integrity in animals is complicated by the associated dysfunction of other organs which accompanies the insult of cardiopulmonary bypass with or without circulatory arrest on the whole body. For example, how should one evaluate an animal undergoing neurological testing which is unable to walk or eat, perhaps because of severe cardiorespiratory or gastrointestinal dysfunction following cardiopulmonary bypass and circulatory arrest. What is the contribution of neurological dysfunction to this state? Most importantly, how is the animal scored which does not survive, even though this may be a result of multiorgan dysfunction?

Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 1)
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Stevenson, DK, Sunshine, P. Fetal and Neonatal Brain Injury. B. C. Decker Inc, Toronto, 1989.Google Scholar
2.Jobsis, FF.Non–invasive, infra-red monitoring of cerebral and myocardial oxygen sufticiency and circulatory parameters. Science 1977; 198: 12641267.CrossRefGoogle Scholar
3.Kawata, H, Fackler, JC, Aoki, M, Tsuji, MK, Sawatari, K, Offurt, M, Hickey, PR, Hokaman, D, Jonas, RA. Recovery of cerebral blood flow and energy state after hypothermic circulatory arrest versus low flow bypass in piglets. J Thorac Cardiovasc Surg 1993. [In press]CrossRefGoogle ScholarPubMed
4.Aoki, M, Nomura, F, Stromski, ME, Tsuji, MK, Fackler, JC, Hickey, PR, Holtzman, D, Jonas, RA. Effects of pH strategy on recovery of piglet brain energetics after hypothermic circula tory arrest. Ann Thorac Surg, 1993. [In press]CrossRefGoogle Scholar
5.Aoki, M, Jonas, BA, Nomura, F, Stromski, M, Tsuji, M, Fackler, J, Hickey, PR, Holtzman, D. Aprotinin enhances acute recov ery of cerebral metabolism after circulatory arrest. Circulation 1992; 86 (Suppl I):I 182.Google Scholar
6.Aoki, M, Jonas, RA, Nomura, F, Kawata, H, Hickey, PR. Impact ofmonoclonal antibody to leukocyte adhesion molecule CD18 on deleterious effects of cardiopulmonary bypass and hypo thermic circulatory arrest in immature piglets. Anesthesiol ogy.[Submitted]Google Scholar
7.Aoki, M, Nomura, F, Stromski, ME, Tsuji, MK, Fackler, JC, Hickey, PR, Holtzman, D, Jonas, BA. Effects of MK-801 and NBQX on acute recovery of piglet cerebral metabolism after hypothermic circulatory arrest. J Cereb Blood Flow Metab. [Submitted]Google Scholar
8.Aoki, M, Nomura, F, Stromski, ME, Tsuji, MK, Hickey, PR, Hokzman, D, Jonas, RA.Effects of pharmacologic modification of cerebroplegia solution on acute recovery of cerebral blood flow and metabolism after hypothermic circulatory arrest. To be presented at The American Association of Thoracic Surgery 1993 Annual Meeting April 25–28, 1993.Google Scholar
9.Swain, JA, McDonald, TJ, Griffith, PK, Balaban, RS, Clark, RE, Ceckler, T. Low flow hypothermic circulatory arrest protects the brain. J Thorac Cardiovasc Surg 1991; 102: 7684.CrossRefGoogle ScholarPubMed
10.Jonas, BA, Wernovsky, G, Ware, J. The Boston Circulatory Arrest Study: Perioperative neurologic outcome after the arterial switch operation. Circulation 1992; 86(Suppl I): I 360.Google Scholar
11.Jonas, RA, Bellinger, DC, Rappaport, LA, Wernovsky, G, Hickey, PR, Farrell, DM, Newburger, JW. pH strategy and develop mental outcome after hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1993. [In press]CrossRefGoogle Scholar
12.Busto, R, Dietrich, WD, Globus, MYT, Valdes, I, Scheinberg, PGinsberg, MD. Small differences in intraischemic brain tem perature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 1987; 7: 729738.CrossRefGoogle Scholar
13.Wong, PC, Barlow, CF, Hickey, PR, Jonas, RA, Castaneda, AR, Farrell, DM, Lock, JE, Wessel, DL. Factors associated with choreoathetosis after cardiopulmonary bypass in children with congenital heart disease. Circulation 1992; 86(Suppl II): II 118II 126.Google ScholarPubMed
14.Becker, H, Vinten-Johansen, J, Buckberg, GD. Myocardial damage caused by keeping pH 7.4 during alkalosis in mainte nance of “ideal” blood pH during hypothermia. J Thorac Cardiovasc Surg 1981; 82: 810820.CrossRefGoogle Scholar
15.Simon, RP, Swan, JH, Griffiths, T, Meldrum, BS. Blockade of N-methyl-D-aspartate receptors may protect against ischemic damage in the brain. Science 1984; 226: 850852.CrossRefGoogle ScholarPubMed
16.Gill, R, Foster, AC, Woodruff, GN. Systemic administration of MK-801 protects against ischemia-induced hippocampal neurodegeneration in the gerbil. J Neurosci 1987; 7: 33433349.CrossRefGoogle ScholarPubMed
17.Sheardown, MJ, Nielson, EO, Hansen, AJ, Jacobsen, P, Honore, T. (1990) 2,3-Dihydroxy-6-nitro-7-sulfamoyl-benzo(F)quin-oxaline: aneuroprotectant for cerebral ischemia. Science, 247: 571574.CrossRefGoogle Scholar
18.Rudolphi, KA, Schubert, P, Parkinson, FE, Fredhoim, BB. Adenosine and brain ischemia. Cerebrovasc Brain Metab Rev 1992; 4: 346369.Google ScholarPubMed
19.Corbett, RJT. In vivo multinuclear magnetic resonance spec troscopy investigations of cerebral development and metabo lism. Scm Perinatal 1990; 14: 258271.Google Scholar
20.Greenamyre, JT, Penney, JB, Young, AB etal. Evidence for transient perinatal glutamatergic innervation ofglobus pallidus. J Neurosci 1987; 7: 10221030.CrossRefGoogle ScholarPubMed
21.Holtzman, D, McFarland, EW, Jacobs, D, Offutt, MC, Neuringer, LJ. Maturational increase in mouse brain creatine kinase reaction rates shown by phosphorous magnetic resonance. Brain Res Dev Brain Res 1991; 22: 181188.CrossRefGoogle Scholar