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Selective cerebral perfusion at 28 degrees C--is the spinal cord safe?
MedLine Citation:
PMID:  19640727     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: To shorten cooling/rewarming associated with hypothermic neuroprotection strategies during complex aortic arch surgery, selective cerebral perfusion (SCP) at 28 degrees C has recently been advocated, although its safe limits - especially with regard to the ischaemic tolerance of the spinal cord - have not been systematically examined. METHODS: Twenty juvenile Yorkshire pigs (30.3+/-2.8kg) were randomly allocated to undergo circulatory arrest and SCP at 28 degrees C for 90 min (group A; N=12) or 120 min (group B; N=8) at 50 mmHg using alpha-stat pH management. Spinal cord blood flow (SCBF) was assessed using fluorescent microspheres at baseline (prior to SCP); at 5 and 80 min during SCP, and at 1, 5 and 48 h after cardiopulmonary bypass (CPB). A modified Tarlov score was used to evaluate neurobehavioural recovery in all survivors blindly from videotapes for 5 days postoperatively. Histological ischaemic spinal cord injury was scored after sacrifice. RESULTS: All pigs could be weaned from CPB and ventilation, but seven pigs (58%) in group A and five (63%) in group B developed multi-organ failure and died within 24h. SCBF diminished immediately after initiation of SCP and was absent throughout SCP in all segments below T8/9, recovering to baseline 1h after SCP at all cord levels. All survivors suffered moderate-to-severe histological lumbar spinal cord damage, more severe in group B (p< or =0.049). Three of five group A pigs recovered normal function, but two suffered paraparesis. Group B survivors had a worse neurologic outcome (p<0.0001): all suffered paraplegia (one immediate, and two on day 2, after initial recovery). CONCLUSION: SCP provides insufficient SCBF below T8/9 to sustain cord viability. At 28 degrees C, the ischaemic tolerance of the cord may be exceeded enough by 90 min to impair function; by 120 min, SCP at 28 degrees C invariably results in paraplegia.
Authors:
Christian D Etz; Maximilian Luehr; Fabian A Kari; Hung Mo Lin; George Kleinman; Stefano Zoli; Konstadinos A Plestis; Randall B Griepp
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Publication Detail:
Type:  Journal Article     Date:  2009-07-28
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  36     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  946-55     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, PO Box 1028, New York, NY 10029, USA. christian.etz@mountsinai.org
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Comment In:
Eur J Cardiothorac Surg. 2009 Dec;36(6):943-5   [PMID:  19766015 ]

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