Preservation of static and dynamic cerebral autoregulation after mild hypothermic cardiopulmonary bypass † †Presented in part at the annual meeting of the American Society of Anesthesiologists, San Francisco, CA, October 14–18, 2000.

Preisman, Sergey; Marks, Roger; Nahtomi-Shick, Orit; Sidi, Avner

doi:10.1093/bja/aei147

Cited by 13 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Monitoring of brain tissue oxygen or jugular venous oxygen saturation (jSvO 2 ) is recommended for patients with acute traumatic brain injury, where therapeutic hyperventilation is used [46] and is important especially during TH. Preserved cerebral autoregulation seems not to be disturbed during TH and early induction of hypothermia after SAH led to faster restoration of cerebrovascular reactivity in vivo [6,47,48]. …”

mentioning

confidence: 99%

Hypothermia and advanced neuromonitoring

et al. 2012

View full text Add to dashboard Cite

mentioning

confidence: 99%

Hypothermia and advanced neuromonitoring

et al. 2012

View full text Add to dashboard Cite

“…However, with respect to neurologic outcome after accidental hypothermia, existing reports of the effects of hypothermia on cerebral autoregulation are conflicting. The majority of preclinical CPB studies ( Mezrow et al, 1992 ; Lee et al, 2011 ; Wang et al, 2019 ), as well as human studies from cardiac surgery ( Preisman et al, 2005 ; Ono et al, 2013 ), suggest protective effects of mild hypothermia (36–34°C) on cerebral autoregulation in post-cardiac arrest states. In contrast, when mimicking the clinical scenario of accidental, deep hypothermia (<30°C), Gaasch et al (2020) reported that although mild hypothermia did not affect indexes of autoregulation, temperatures below 34°C were associated with altered cerebral autoregulation.…”

Section: Discussionmentioning

confidence: 99%

Autoregulation of Cerebral Blood Flow During 3-h Continuous Cardiopulmonary Resuscitation at 27°C

Valkov

Nilsen²,

Mohyuddin³

et al. 2022

Front. Physiol.

View full text Add to dashboard Cite

Introduction: Victims of accidental hypothermia in hypothermic cardiac arrest (HCA) may survive with favorable neurologic outcome if early and continuous prehospital cardiopulmonary resuscitation (CPR) is started and continued during evacuation and transport. The efficacy of cerebral autoregulation during hypothermic CPR is largely unknown and is aim of the present experiment.Methods: Anesthetized pigs (n = 8) were surface cooled to HCA at 27°C before 3 h continuous CPR. Central hemodynamics, cerebral O2 delivery (DO2) and uptake (VO2), cerebral blood flow (CBF), and cerebral perfusion pressure (CPP) were determined before cooling, at 32°C and at 27°C, then at 15 min after the start of CPR, and hourly thereafter. To estimate cerebral autoregulation, the static autoregulatory index (sARI), and the CBF/VO2 ratio were determined.Results: After the initial 15-min period of CPR at 27°C, cardiac output (CO) and mean arterial pressure (MAP) were reduced significantly when compared to corresponding values during spontaneous circulation at 27°C (−66.7% and −44.4%, respectively), and remained reduced during the subsequent 3-h period of CPR. During the first 2-h period of CPR at 27°C, blood flow in five different brain areas remained unchanged when compared to the level during spontaneous circulation at 27°C, but after 3 h of CPR blood flow in 2 of the 5 areas was significantly reduced. Cooling to 27°C reduced cerebral DO2 by 67.3% and VO2 by 84.4%. Cerebral VO2 was significantly reduced first after 3 h of CPR. Cerebral DO2 remained unaltered compared to corresponding levels measured during spontaneous circulation at 27°C. Cerebral autoregulation was preserved (sARI > 0.4), at least during the first 2 h of CPR. Interestingly, the CBF/VO2 ratio during spontaneous circulation at 27°C indicated the presence of an affluent cerebral DO2, whereas after CPR, the CBF/VO2 ratio returned to the level of spontaneous circulation at 38°C.Conclusion: Despite a reduced CO, continuous CPR for 3 h at 27°C provided sufficient cerebral DO2 to maintain aerobic metabolism and to preserve cerebral autoregulation during the first 2-h period of CPR. This new information supports early start and continued CPR in accidental hypothermia patients during rescue and transportation for in hospital rewarming.

show abstract

Section: Methodsmentioning

confidence: 99%

“…Using measured rSO 2 and cerebral perfusion pressure (CPP) (defined as the difference between MAP and central venous pressure (CVP)), 18 assuming that intracranial pressure was lower than CVP, [19][20][21][22] COx was calculated using the Spearman rank correlation test. 12,13 Values for CPP and rSO 2 were collected every minute, and individual COx value for the patients of each group was calculated.…”

Section: Brain Oxygenation and Cerebral Blood Flowmentioning

confidence: 99%

Cerebral oxygenation and autoregulation during rewarming on cardiopulmonary bypass

et al. 2022

View full text Add to dashboard Cite

Background Rewarming on cardiopulmonary bypass (CPB) is associated with increased metabolic demands; however, it remains unclear whether cerebral autoregulation is affected during this phase. This RCT aims to describe the effects of 20% supranormal, compared to normal CPB flow, on monitoring signs of inadequate perfusion, oxygenation, and disturbed cerebral autoregulation, during the rewarming phase of CPB. Method Thirty two patients scheduled for coronary artery bypass grafting were allocated to a Control group ( n = 16) receiving a CPB pump flow corresponding to preoperatively measured cardiac output, and an Intervention group ( n = 16) receiving the corresponding CPB pump flow increased by 20% during rewarming. Cerebral Oximetry Index (COx) was calculated with the aid of Near Infrared Spectroscopy. Results Twenty five patients were included in the data. Results show a median COx value of 0.0 (IQR −0.33–0.5) (Control) and 0.0 (IQR −0.15–0.25) (Intervention), respectively; p = .85 with individual variations within groups. The median cerebral perfusion pressure (CPP) was 55 (52–58) (Control) and 61 (54–66) mmHg (Intervention); p = .08. No significant difference in rSO2 values was observed between the groups (58.5% (50–61) versus 64% (58–68); p = .06). Conclusion The present study showed no difference between increased and normal CPB pump flow with respect to cerebral autoregulation during rewarming. Large variations in cerebral autoregulation were seen at individual level.

show abstract

Preservation of static and dynamic cerebral autoregulation after mild hypothermic cardiopulmonary bypass † †Presented in part at the annual meeting of the American Society of Anesthesiologists, San Francisco, CA, October 14–18, 2000.

Abstract: Autoregulation of cerebral blood flow remains preserved after mild hypothermic CPB.

Cited by 13 publications

References 19 publications

Hypothermia and advanced neuromonitoring

Hypothermia and advanced neuromonitoring

Autoregulation of Cerebral Blood Flow During 3-h Continuous Cardiopulmonary Resuscitation at 27°C

Cerebral oxygenation and autoregulation during rewarming on cardiopulmonary bypass

Contact Info

Product

Resources

About