Differential brain and body temperature during cardiopulmonary bypass?a randomised clinical study*1

Abstract

Differential temperature management using the Cobra aortic catheter is possible. Further studies are necessary to establish whether the hypothesized advantages of combining corporeal normothermia with brain hypothermia can be realised.

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass

“…Multiple authors, including Kaukuntla et al ( 50 ), suggest slow rewarming to avoid heterogeneous changes in brain temperature, and similarly, Murphy et al ( 22 ) support gradual rewarming compared with rapid rewarming. Scheffer and Sanders ( 10 ) promote slow rewarming for a number of reasons including 1) avoidance of excess cerebral oxygen extraction and jugular venous desaturation; 2) improved maintenance of the relationship between cerebral blood flow and the cerebral metabolic rate of oxygen; and 3) increased time for better distribution of heat.…”

Selective brain hypothermia: feasibility and safety study of a novel method in five patients

“…38 Unfortunately, in spite of rapid brain-targeted cooling, clinical results were disappointing with Cobra. 39,40 Cardeon's technology required deployment of a larger than normal bore catheter into the aorta, followed by inflation of baffles within the aortic arch to direct blood flow which may have increased embolic burden. Also, Cardeon's technology is CPB-based and does not offer brain protection prior to CPB initiation, during active rewarming via CPB, nor after CPB conclusion.…”

The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass—Temperature Management During Cardiopulmonary Bypass

“…Multiple authors, including Kaukuntla and colleagues [50] (2004), suggest slow rewarming to avoid heterogeneous changes in brain temperature, and similarly, Murphy and colleagues [22] (2009) support gradual rewarming compared with rapid rewarming. Scheffer and Sanders [10] (2003) promote slow rewarming for a number of reasons including: (1) avoidance of excess cerebral oxygen extraction and jugular venous desaturation; (2) improved maintenance of the relationship between cerebral blood flow and the cerebral metabolic rate of oxygen, and (3) increased time for better distribution of heat.…”