Recovery of cerebral metabolism and mitochondrial oxidation state is delayed after hypothermic circulatory arrest

To study the effect of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism and oxygenation, we measured the cerebral metabolic rate for oxygen (CMRO2) and assessed brain oxygenation by near infrared spectroscopy before, during, and after hypothermic bypass in...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1991-11, Vol.84 (5 Suppl), p.III400-III406
Main Authors: Greeley, W J, Bracey, V A, Ungerleider, R M, Greibel, J A, Kern, F H, Boyd, J L, Reves, J G, Piantadosi, C A
Format: Article
Language:English
Subjects:
Brain - metabolism
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Child, Preschool
Electron Transport Complex IV - metabolism
Heart Arrest, Induced
Humans
Hypothermia, Induced
Infant
Infant, Newborn
Monitoring, Intraoperative - methods
Oxidation-Reduction
Oxygen Consumption - physiology
Oxyhemoglobins - metabolism
Spectrophotometry, Infrared
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Summary:To study the effect of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism and oxygenation, we measured the cerebral metabolic rate for oxygen (CMRO2) and assessed brain oxygenation by near infrared spectroscopy before, during, and after hypothermic bypass in 15 pediatric patients. One group underwent repair during deep hypothermic bypass (18 degrees C) with continuous flow (n = 9); the second group underwent deep hypothermic bypass with total circulatory arrest (n = 6). In the continuous-flow group, CMRO2 returned to control during rewarming and after cardiopulmonary bypass, as did oxyhemoglobin and deoxyhemoglobin in brain tissue. In the total circulatory arrest group, the oxyhemoglobin and the oxidation state of cytochrome aa3 oxidase decreased significantly during circulatory arrest. After cardiopulmonary bypass, the cytochrome oxidation state and the CMRO2 were significantly lower than control measurements, and brain tissue deoxyhemoglobin was elevated. Results of this study indicate that intracellular brain oxygenation decreases significantly during circulatory arrest and remains impaired after rewarming and cardiopulmonary bypass despite normalization of oxygen availability.
ISSN:0009-7322