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Computer-controlled cardiopulmonary bypass increases jugular venous oxygen saturation during rewarming
W A Mutch1, G R Lefevre, D B Thiessen
1Department of Anesthesia, University of Manitoba, Winnipeg, Canada. mutch@bldghsc.lan1.umanitoba.ca
The Annals of Thoracic Surgery
|February 10, 1998
Summary
Computer-controlled pulsatile cardiopulmonary bypass (CPB) better preserves cerebral oxygenation during rewarming from hypothermia than conventional apulsatile CPB. This pulsatile technique recreates biological variability, leading to improved jugular venous oxygen saturation (SjvO2) levels.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Physiology
Background:
- Conventional apulsatile cardiopulmonary bypass (CPB) lacks biological variability.
- Computer-controlled pulsatile CPB aims to replicate beat-to-beat variations in rate and pressure.
- Low jugular venous oxygen saturation (SjvO2 < 50%) during rewarming from hypothermic CPB is linked to cognitive dysfunction.
Purpose of the Study:
- To compare the efficacy of apulsatile versus computer-controlled pulsatile CPB in maintaining cerebral oxygenation.
- To evaluate jugular venous oxygen saturation (SjvO2) levels during rewarming from hypothermic CPB in pigs.
Main Methods:
- Pigs underwent 3-hour CPB with membrane oxygenation and alpha-stat management.
- Animals were randomized to either apulsatile CPB (n=12) or computer-controlled pulsatile CPB (n=12).
- SjvO2 was measured at 5-minute intervals during rewarming from 28°C nasopharyngeal temperature.
Main Results:
- No significant differences in temperature, rewarming rate, or blood gas parameters were observed between groups.
- Pulsatile CPB generated significantly higher mean pulse pressure (20.7 mmHg) compared to apulsatile CPB (10.0 mmHg).
- Apulsatile CPB resulted in markedly greater mean and cumulative areas for SjvO2 < 50% compared to pulsatile CPB.
Conclusions:
- Computer-controlled pulsatile CPB significantly improved SjvO2 during rewarming from hypothermic CPB.
- The pulsatile technique, by restoring biologic variability, appears to better preserve cerebral oxygenation.
- Results suggest pulsatile CPB may reduce the risk of cognitive dysfunction associated with low SjvO2.