A multimodality approach lengthens warm ischemic time during aortic cross-clamping

Area of Science:

• Neuroscience
• Cardiovascular Surgery
• Pharmacology

Background:

• Spinal cord ischemia can lead to severe neurological deficits.
• Maintaining spinal cord perfusion pressure (SCPP) is critical during procedures involving aortic cross-clamping.
• Cerebrospinal fluid drainage (CSFD) and steroid administration are potential strategies to improve outcomes.

Purpose of the Study:

• To evaluate the impact of exsanguination, CSFD, steroids, and their combination on SCPP.
• To assess neurological outcomes following spinal cord ischemia.
• To determine the efficacy of interventions in managing spinal cord perfusion during aortic occlusion.

Main Methods:

• 29 mongrel dogs underwent 70 minutes of normothermic spinal cord ischemia.
• Proximal and distal aortic blood pressure, cerebrospinal fluid pressure, and somatosensory evoked potentials were monitored.
• Animals were randomized into four groups: control, steroids only, CSFD only, and steroids with CSFD. Partial exsanguination controlled blood pressure during aortic cross-clamping.

Main Results:

• Partial exsanguination effectively controlled proximal aortic blood pressure across all groups.
• Distal aortic blood pressure significantly decreased in all groups post-occlusion but did not differ among them.
• Cerebrospinal fluid pressure was significantly reduced by steroids alone and further reduced by CSFD, especially when combined with steroids.

Conclusions:

• Cerebrospinal fluid drainage, particularly when combined with steroids, effectively reduces cerebrospinal fluid pressure during spinal cord ischemia.
• These interventions may help improve spinal cord perfusion pressure and potentially neurological outcomes.
• Further research is needed to fully elucidate the neurological benefits of these combined strategies.