Markers of peripheral perfusion during high-flow regional cerebral perfusion for aortic arch repair.

Abstract

High-flow regional cerebral perfusion (HFRCP) provides cerebral and somatic oxygen delivery through collateral vessels during aortic arch repair in small children; however, optimal flow conditions during HFRCP have not been established. We sought to identify markers of peripheral perfusion during HFRCP. Between 2009 and 2016, in total 20 consecutive pediatric patients undergoing aortic arch repair with HFRCP were enrolled in this prospective, observational study. Median age was 20 days (range, 6-116 days); median body weight was 2.77 kg (range, 1.8-4.98 kg). Oxygen delivery ratio (Do₂R) was calculated as the oxygen delivery during HFRCP divided by the oxygen delivery before HFRCP. Regional oxygen saturations on the forehead and on the thigh (rSo₂T) were monitored during HFRCP, and postoperative creatinine kinase and lactate concentrations were measured as postoperative outcomes. Multivariate analyses were performed to clarify the effectiveness of Do₂R and rSo₂T as markers of peripheral perfusion during HFRCP. No deaths or neurologic impairments occurred. Multivariate analysis showed that the lowest rSo₂T (P = .005) and cardiopulmonary bypass time (P = .012) predicted postoperative creatinine kinase concentration. Do₂R was the only factor to predict postoperative lactate concentration (P < .001). Receiver operating characteristic analysis showed that Do₂R less than 0.66 predicted risk of high postoperative lactate concentration (>5.0 mmol/L), with area under the curve of 0.95. For aortic arch repair in small children, rSo₂T and Do₂R during HFRCP are useful markers for predicting peripheral perfusion. Maintaining higher Do₂R during HFRCP minimizes postoperative increases in lactate and creatinine kinase concentrations.