Blood gas management and degree of cooling: Effects on cerebral metabolism before and after circulatory arrest Lynne A. Skaryak, MDa, Paul J. Chai, MDa,

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Blood gas management and degree of cooling: Effects on cerebral metabolism before and after circulatory arrest Lynne A. Skaryak, MDa, Paul J. Chai, MDa, Frank H. Kern, MDb, William J. Greeley, MDb, Ross M. Ungerleider, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 110, Issue 6, Pages 1649-1657 (December 1995) DOI: 10.1016/S0022-5223(95)70026-9 Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 Experimental protocol and data collection sequence. After instrumentation, animals were placed on CPB at 100 ml/kg per minute and 37° C and baseline measurements (I) were obtained. Animals were cooled to 18° or 14° C over 23 minutes and data (II) were obtained. Experimental groups were cooled as follows: α(18°C), alpha-stat strategy to 18°C (n = 9); (18°C), pH-stat strategy to 18°C (n = 9); pH→α(18°C), pH-stat strategy for 18 minutes followed by switch to alpha-stat strategy for last 5 minutes of cooling to 18°C (n = 12); α(14°C), alpha-stat strategy to 14°C (n = 6); pH(14°C), pH-stat strategy to 14°C (n = 7); pH→α(14°C), pH-stat strategy for 18 minutes followed by switch to alpha-stat strategy for last 5 minutes of cooling to 14°C (n = 10). Animals underwent 60 minutes of DHCA followed by rewarming to 36°C over 26-minute period. Final measurements were obtained at this time (III). Not shown in this schematic are control animals, which were cooled with alpha-stat strategy to 18°C (CTL[18°C], n = 10) or 14°C (CTL[14°C], n = 3) followed by 60 minutes of deep hypothermic CPB (100 ml/kg per minute). The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1649-1657DOI: (10.1016/S0022-5223(95)70026-9) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 CMRO2 measurements before DHCA at maximal cooling (18° or 14°C). CMRO2 is more suppressed at 14°C compared with value at 18°C. At any given temperature (18° or 14°C), pH-stat strategy provides better suppression of CMRO2. Mean data plus or minus standard error are shown. *p < 0.005 versus all other groups at maximal cooling. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1649-1657DOI: (10.1016/S0022-5223(95)70026-9) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 CMRO2 measurements before and after deep hypothermic CPB or DHCA. Control (CTL) animals had almost complete return of CMRO2 to baseline values after deep hypothermic CPB. There was significant decrease in CMRO2 from stage I to stage III in all animals undergoing 60 minutes of DHCA. Mean data plus or minus standard error are shown. *p < 0.05, stage II versus stage I; †p < 0.005, pH(14°C) versus pH(18°C); I, CPB (37°C); III, CPB (36°C) after rewarming. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1649-1657DOI: (10.1016/S0022-5223(95)70026-9) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4 CMRO2 measurements before and after DHCA in those animals cooled to 14°C. There was significant decrease in CMRO2 from stage I to stage III in all animals. At stage III, there was significant decrease in CMRO2 in alpha-stat and pH-stat groups compared with values in pH→α-stat group animals. Mean data plus or minus standard error are given. *p < 0.05, stage III versus stage I; †p < 0.05, pH→α-stat versus alpha-stat and pH-stat; I, CPB (37°C); III,CPB (36°C) after rewarming. The Journal of Thoracic and Cardiovascular Surgery 1995 110, 1649-1657DOI: (10.1016/S0022-5223(95)70026-9) Copyright © 1995 Mosby, Inc. Terms and Conditions