Optimal flow rate for antegrade cerebral perfusion

Sasaki, Takashi; Tsuda, Shoichi; Riemer, R. Kirk; Ramamoorthy, Chandra; Reddy, V. Mohan; Hanley, Frank L.

doi:10.1016/j.jtcvs.2009.12.005

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 530-535, March 2010

Optimal flow rate for antegrade cerebral perfusion

Takashi Sasaki, MD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford, Calif
Shoichi Tsuda, MD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford, Calif
R. Kirk Riemer, PhD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford, Calif
Chandra Ramamoorthy, MD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Anesthesiology, Stanford, Calif
V. Mohan Reddy, MD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford, Calif
Frank L. Hanley, MD
- Stanford University, Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford, Calif
- Address for reprints: Frank L. Hanley, MD, Stanford University, Department of Cardiothoracic Surgery, 300 Pasteur Drive, Falk Rm CV116C, Stanford, CA 94305-5407.

Received 1 July 2009; received in revised form 24 November 2009; accepted 7 December 2009.

Objective

Antegrade cerebral perfusion is widely used in neonatal heart surgery, yet commonly used flow rates have never been standardized. The objective of this study was to determine the antegrade cerebral perfusion flow rate that most closely matches standard cardiopulmonary bypass conditions.

Methods

Nine neonatal piglets underwent deep hypothermic cardiopulmonary bypass at a total body flow of 100 mL/kg/min (baseline). Antegrade cerebral perfusion was conducted via innominate artery cannulation at perfusion rates of 10, 30, and 50 mL/kg/min in random order. Cerebral blood flow was measured using fluorescent microspheres. Regional oxygen saturation and cerebral oxygen extraction were monitored.

Results

Cerebral blood flow was as follows: baseline, 60 ± 17 mL/100 g/min; antegrade cerebral perfusion at 50 mL/kg/min, 56 ± 17 mL/100 g/min; antegrade cerebral perfusion at 30 mL/kg/min, 36 ± 9 mL/100 g/min; and antegrade cerebral perfusion at 10 mL/kg/min, 13 ± 6 mL/100 g/min. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow matched baseline (P = .87), as did regional oxygen saturation (P = .13). Antegrade cerebral perfusion at 30 mL/kg/min provided approximately 60% of baseline cerebral blood flow (P < .002); however, regional oxygen saturation was equal to baseline (P = .93). Antegrade cerebral perfusion at 10 mL/kg/min provided 20% of baseline cerebral blood flow (P < .001) and a lower regional oxygen saturation than baseline (P = .011). Cerebral oxygen extraction at antegrade cerebral perfusion rates of 30 and 50 mL/kg/min was equal to baseline (P = .53, .48) but greater than baseline (P < .0001) at an antegrade cerebral perfusion rate of 10 mL/kg/min. The distributions of cerebral blood flow and regional oxygen saturation were equal in each brain hemisphere at all antegrade cerebral perfusion rates.

Conclusion

Cerebral blood flow increased with antegrade cerebral perfusion rate. At an antegrade cerebral perfusion rate of 50 mL/kg/min, cerebral blood flow was equal to baseline, but regional oxygen saturation and cerebral oxygen extraction trends suggested more oxygenation than baseline. An antegrade cerebral perfusion rate of 30 mL/kg/min provided only 60% of baseline cerebral blood flow, but cerebral oxygen extraction and regional oxygen saturation were equal to baseline. An antegrade cerebral perfusion rate that closely matches standard cardiopulmonary bypass conditions is between 30 and 50 mL/kg/min.

CTSNet classification: 19, 20

Abbreviations and Acronyms: ACP, antegrade cerebral perfusion, CBF, cerebral blood flow, CPB, cardiopulmonary bypass, DHCA, deep hypothermic circulatory arrest, NIRS, near-infrared spectroscopy, rSO2, regional oxygen saturation