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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Selective cerebral perfusion using moderate flow in complex cardiac surgery provides sufficient neuroprotection. Are
Fabian Emrich1, Thomas Walther, Petra Muth
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. fabian.emrich@t-online.de
Insights
Selective cerebral perfusion (SCP) at moderate flow levels is safe for the brain during cardiac surgery. However, extensive hypoperfusion during SCP can cause significant brain injury, indicating a need for careful flow management.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Pediatric Cardiology
Background:
- Selective cerebral perfusion (SCP) is a critical technique during complex congenital cardiac defect repair.
- Understanding the impact of SCP flow rates on brain ischemia is essential for patient safety.
Purpose of the Study:
- To evaluate the effects of varying selective cerebral perfusion flow levels on brain ischemia.
- To determine the threshold for hypoperfusion-induced brain injury during SCP.
Main Methods:
- Piglet model (n=15) underwent cardiopulmonary bypass with SCP at 25°C for 90 minutes.
- Evaluated regular (1 ml/g/min), moderate (0.5 ml/g/min), and extensive (0.25 ml/g/min) hypoperfusion.
- Monitored clinical parameters, tissue oxygenation index (TOI), and performed hippocampal histology for apoptosis markers.
Main Results:
- Intracranial pressure and hemodynamic parameters remained stable across all groups.
- Extensive hypoperfusion moderately reduced TOI.
- Increased nitrotyrosine and apoptosis-inducing factor positive cells in the hippocampus were observed with extensive hypoperfusion (P < 0.05).
Conclusions:
- Moderate SCP flow rates are comparable to normal brain perfusion regarding brain injury markers.
- Extensive hypoperfusion during SCP is associated with significant morphological brain injury.
- Moderate hypoperfusion may help prevent cerebral edema and reduce brain injury risk.
Objective:
Selective cerebral perfusion (SCP) is commonly applied during the correction of complex congenital cardiac defects. In this study, we assessed the impact of different flow levels of SCP on potential brain ischaemia.
Methods:
Fifteen piglets (7-10 kg, age 3-4 weeks) received SCP via the right common carotid artery during cardiopulmonary bypass at 25°C for 90 min. Regular brain perfusion (1 ml/g brain weight/min), moderate hypoperfusion (0.5 ml/g/min) and extensive hypoperfusion (0.25 ml/g/min) were evaluated. Clinical parameters and tissue oxygenation index (TOI) were registered online until 3 h of reperfusion. Hematoxylin and eosin (HE) staining and immunohistological analyses for apoptosis inducing factor (AIF) and nitrotyrosine (NO-Tyr) were performed on sections of the hippocampus.
Results:
Intracerebral pressure remained stable throughout the study. Haemodynamic parameters, blood gas and lactate measurements were stable until the end of the study. Extensive hypoperfusion led to a moderate reduction of TOI. NO-Tyr immuno-positive cells were 15.7% at regular cerebral perfusion, 23.9% at moderate hypoperfusion (P = n.s.) and 46.1% at extensive hypoperfusion (P < 0.05). AIF immuno-positive nuclei were present in 8.3% of the hippocampus cells after regular perfusion, in 10.8% after moderate hypoperfusion (P = n.s.) and in 17.9% after extensive hypoperfusion (P < 0.05).
Conclusions:
SCP using a moderate SCP flow regime demonstrates comparable results to normal brain perfusion while after extensive hypoperfusion significant morphological brain injury could be found. Thus moderate, but not extensive, hypoperfusion might have the potential to prevent perfusion-related cerebral oedema and an increasing risk of brain injury.
