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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 2000 Febbraio;41(1):1-6
Effects of temperature strategy during cardiopulmonary bypass on cerebral oxygen balance
Ip-Yam P. C., Thomas S. D., Jackson M. *, Rashid A. *, Behl S. *
From the Department of Anaesthesia Royal Liverpool University Hospital, Liverpool, UK
*Cardiothoracic Centre, Liverpool, UK
Background. Cerebral injury is the most serious complication of cardiopulmonary perfusion (CPB). With the advent of warm heart surgery, the effect of temperature strategy during perfusion and its effect on cerebral oxygen balance needs further study.
Methods. Three groups of patients (n=8, each) undergoing coronary artery bypass graft (CABG) surgery were studied. Group H, M and N underwent CPB at 28°C, 32°C and normothermia (>36°C), respectively. The extracorporeal circuit was primed with Hartmann’s solution 2.5 l and flow of 1.8 l min-1 m-2 at 28°C, and 2.4 l min-1 m-2 at 32°C and normothermia. All patients had a 4F oximetry catheter (Opticath, Oximetrix, Abbott Laboratories) inserted in the right jugular bulb for continuous measurement of jugular venous oxygen saturation (sjvO2). Data was collected at six specific times: T1- within 5 min before initiation of CPB, T2 - within the first minute after CPB, T3 - during stable temperature on CPB (28°C, 32°C, >36°C), T4 - during rewarming at 34°C in groups H and M, 15 min before coming off CPB in group N, T5 - 15 min after CPB, T6 - skin closure. At each time mean arterial pressure (MAP) and sjvO2 were recorded. Arterial blood and jugular venous blood were sampled for measurement of arterial oxygen saturation (saO2) and jugular venous lactate (sjvlactate), respectively.
Results. SjvO2 values decreased at times T2, T3 and T4 when compared to baseline (p<0.05) but there were no significant group differences at any time. Cerebral arteriovenous oxygen saturation (a-jvO2) differences mirrored sjvO2 changes. Sjvlactate values increased from baseline following CPB but fell consistently with time - there were no significant group differences at each time point. SjvO2 and a-jvO2 values were not significantly correlated with sjvlactate.
Conclusion. During pump flows employed in this study, cerebral oxygen balance and perfusion appear unaffected by temperature.