Lynne A. Skaryak, MDa (by invitation), Paul M

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Presentation transcript:

Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest Lynne A. Skaryak, MDa (by invitation), Paul M. Kirshbom, MDa (by invitation), Louis R. DiBernardo, MDa (by invitation), Frank H. Kern, MDb (by invitation), William J. Greeley, MDa (by invitation), Ross M. Ungerleider, MDa (by invitation), J.William Gaynor, MDa (by invitation) The Journal of Thoracic and Cardiovascular Surgery Volume 109, Issue 4, Pages 744-752 (April 1995) DOI: 10.1016/S0022-5223(95)70357-8 Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 Modified placement of the hemofilter after separation from CPB and during ultrafiltration. UF, Ultrafilter. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 744-752DOI: (10.1016/S0022-5223(95)70357-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 Experimental protocol and data collection sequence: After instrumentation, baseline measurements (I) were obtained. Animals were supported by CPB at 100 ml · kg-1 · min-1 and 37° C, and then cooled to 18° C over 23 minutes. Animals underwent 90 minutes of DHCA, followed by rewarming to 36° C over a 27-minute period. Data were obtained 5 minutes after separation from CPB (II). The experimental groups were as follows: A, CTL, Observation for 20 minutes without intervention (n = 10); B, MUF, modified ultrafiltration for 16 minutes (n = 9); C, Tx, transfusion of hemoconcentrated blood over 20 minutes (n = 7). Final measurements were then obtained 25 minutes after separation from CPB (III). The Journal of Thoracic and Cardiovascular Surgery 1995 109, 744-752DOI: (10.1016/S0022-5223(95)70357-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3 Cerebral oxygen delivery ( cD · O2 ) measurements before and after DHCA. There was a significant decrease in cD · O2 in CTL animals compared with MUF and Tx groups at stage III. Mean data ± standard error; *p ± 0.0001, CTL versus MUF and Tx. CTL, Control; MUF, ultrafiltration; Tx, transfusion. I, Before CPB; II, 5 minutes after CPB; III, 25 minutes after CPB. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 744-752DOI: (10.1016/S0022-5223(95)70357-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4 CMRO2 measurements before and after DHCA. There was a significant increase in CMRO2 in MUF animals compared with CTL and Tx groups at stage III. Mean data ± standard error; *p < 0.001, MUF versus CTL and Tx. CTL, Control; MUF, ultrafiltration; Tx, transfusion. I, Before CPB; II, 5 minutes after CPB; III, 25 minutes after CPB. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 744-752DOI: (10.1016/S0022-5223(95)70357-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 5 Hypothetical cerebral oxygen supply and demand curves at 25 minutes after separation from CPB after DHCA. In this model CMRO2 does not change significantly with varying levels of cerebral oxygen delivery (cD · O2 ), suggesting that control and transfusion animals are on the supply-independent (flat) portion of the curve. The ability of MUF to increase both cD · O2 and CMRO2 implies that these animals are on a different curve than control and transfusion animals. From the current study it cannot be determined if the MUF animals are on the supply-dependent (straight dotted line) or supply-independent (curved dotted line) portion of the curve. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 744-752DOI: (10.1016/S0022-5223(95)70357-8) Copyright © 1995 Mosby, Inc. Terms and Conditions