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Title: Direct cerebral perfusion and cooling in experimental cardiac arrest.
Austin Authors: Bellomo, Rinaldo ;Marino, Bruno;Angelopoulos, Peter;Carson, Scott ;Eastwood, Glenn;Kosaka, Junko;Iguchi, Naoya;Hilton, Andrew K ;May, Clive
Affiliation: The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Perfusion Services, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Dec-2016
Publication information: Critical Care and Resuscitation 2016; 18(4): 255-260
Abstract: Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. To test whether direct perfusion and cooling of the anterior cerebral circulation by means of cerebral vessel cannulation and extracorporeal membrane oxygenation (ECMO) increases cerebral oxygenation and induces cerebral hypothermia during CA. We performed proof-of-concept animal experiments in sheep. We cannulated the carotid artery (for antegrade perfusion) or the jugular vein (for retrograde perfusion) for direct perfusion and cooling, and the jugular vein on the opposite side for drainage. We connected these cannulae to an ECMO circuit. We induced CA and, after 10 minutes, and during open-chest cardiac massage, we provided ECMO-based perfusion and cooling. We measured cerebral tissue oxygen saturation (SctO2) by near infrared spectroscopy (NIRS) and cerebral temperature by means of invasively inserted tissue temperature probes. In the antegrade perfusion experiments (n = 2), CA markedly decreased the SctO2 to below 40% over 10 minutes, despite open-chest cardiac massage. ECMO-based cerebral perfusion and cooling increased SctO2 levels to 60% and lowered cerebral temperature to 25°C within about 3 minutes. With retrograde perfusion (n = 2), ECMObased cerebral perfusion and cooling was less effective; ECMO increased SctO2 levels slowly and to a much lesser extent and similarly decreased cerebral temperature slowly and to a lesser extent. During experimental CA, cerebral perfusion and cooling are possible by means of an ECMO circuit connected to the anterior cerebral circulation. Antegrade perfusion appears to be superior. Further investigations of the antegrade perfusion technique appear justified.
ORCID: 0000-0002-1650-8939
Journal: Critical Care and Resuscitation
PubMed URL: 27903207
ISSN: 1441-2772
Type: Journal Article
Appears in Collections:Journal articles

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