Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning Fredrik S. Yannopoulos, MB, Tuomas Mäkelä, MB, Eija.

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Improved Cerebral Recovery From Hypothermic Circulatory Arrest After Remote Ischemic Preconditioning Fredrik S. Yannopoulos, MB, Tuomas Mäkelä, MB, Eija Niemelä, MB, Hannu Tuominen, MD, PhD, Pasi Lepola, MS, Kirsi Alestalo, MB, Hanna Kaakinen, MD, PhD, Kai Kiviluoma, MD, PhD, Vesa Anttila, MD, PhD, Tatu Juvonen, MD, PhD The Annals of Thoracic Surgery Volume 90, Issue 1, Pages 182-188 (July 2010) DOI: 10.1016/j.athoracsur.2010.03.058 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Troponin I (TnI) measurements show that, compared with the transient remote ischemic (TRI) preconditioning group (solid squares), the control group (open triangles) has a slightly higher TnI concentration at 4 hours and a statistically significant difference at 8 hours after the end of hypothermic circulatory arrest (HCA). *p < 0.05. The Annals of Thoracic Surgery 2010 90, 182-188DOI: (10.1016/j.athoracsur.2010.03.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Samples for transient remote ischemic (TRI) preconditioning group (solid squares) and control group (open triangles) collected through a microdialysis pump show intracerebral concentrations of (A) glucose, (B) glycerol, (C) pyruvate, and (D) lactate at baseline, during hypothermic circulatory arrest (HCA), and after the start of rewarming. Values represent median values; error bars represent interquartile range.* = p < 0.05; ** = p < 0.001 at a single timepoint; pg = p value between groups (level of difference between groups); pt*g = p value time * group (behavior between groups over time). The Annals of Thoracic Surgery 2010 90, 182-188DOI: (10.1016/j.athoracsur.2010.03.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Electroencephalogram (EEG) recovery ratio, transient remote ischemic (TRI) preconditioning group (solid squares) versus control group (open triangles), shows the relative quantity of spontaneous bursts to burst suppression periods in percentages when compared with baseline measurements (100%). The EEG recovery ratio was measured at every timepoint continuously for 5 minutes. * = p < 0.05 at a single timepoint; pg = p value between groups (level of difference between groups); pt*g = p value time * group (behavior between groups over time). (HCA = hypothermic circulatory arrest.) The Annals of Thoracic Surgery 2010 90, 182-188DOI: (10.1016/j.athoracsur.2010.03.058) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions