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Cardiopulmonary bypass increases permeability of the blood-cerebrospinal fluid barrier

Toru Okamura1, Nobuyuki Ishibashi, David Zurakowski

  • 1Department of Cardiovascular Surgery, Children's National Medical Center, Washington, DC 20010, USA.

The Annals of Thoracic Surgery
|January 28, 2010
PubMed

Insights

Hypothermic circulatory arrest (HCA) during cardiopulmonary bypass (CPB) impairs the blood-cerebrospinal fluid barrier. This study in piglets shows HCA significantly increases albumin ratio, indicating barrier disruption, suggesting neuroprotection needs further study.

Area of Science:

  • Cardiovascular Surgery
  • Neuroscience
  • Pediatric Critical Care

Background:

  • The integrity of the blood-cerebrospinal fluid (CSF) barrier during cardiopulmonary bypass (CPB) with hypothermic circulatory arrest (HCA) is not well understood, particularly in pediatric patients.
  • CPB is a critical procedure in cardiac surgery, and understanding its effects on the brain is vital for patient outcomes.

Purpose of the Study:

  • To investigate the impact of CPB, with and without HCA, on the integrity of the blood-CSF barrier.
  • To test the hypothesis that CPB disrupts the blood-CSF barrier.

Main Methods:

  • A randomized study involving 25 piglets subjected to different CPB conditions: normothermia (37°C), hypothermia (25°C), and HCA (15°C and 25°C).
  • CSF and plasma samples were collected at multiple time points to measure albumin levels and calculate the albumin ratio (Q(Alb)) as an indicator of barrier integrity.
  • A pH-stat strategy was employed during CPB.

Main Results:

  • The albumin ratio (Q(Alb)) was significantly elevated in piglets undergoing HCA at both 15°C and 25°C compared to control and normothermic CPB groups (p < 0.05).
  • Normothermic CPB (37°C) did not significantly alter Q(Alb) compared to the control group.

Conclusions:

  • CPB combined with HCA for one hour significantly impairs the blood-CSF barrier.
  • Further research is necessary to elucidate the mechanisms of blood-CSF barrier changes during CPB and their implications for neuroprotection.
Abstract

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