Intermittent whole-body perfusion with "somatoplegia' versus blood perfusate to extend duration of circulatory arrest.

Abstract

Continuous whole-body perfusion for > 3 hours with a cold asanguineous blood substitute, hypothermosol (HTS) solution, has been reported to preserve organ function. We used this solution in a survival animal model to evaluate its possible application in extending the safe duration of deep hypothermic circulatory arrest (DHCA). Fifteen piglets were placed on cardiopulmonary bypass (CPB), were cooled to a nasopharyngeal temperature of 15 degrees C, and underwent 100 minutes of DHCA. Control animals (group C, n = 5) had uninterrupted DHCA, group HTS animals were perfused with maintenance HTS for 5 minutes every 25 minutes during DHCA (n = 5), and group B animals were intermittently perfused as for group HTS with the blood in the bypass circuit (n = 5). Cerebral oxygenation was assessed with near-infrared spectroscopy throughout CPB and DHCA. Animals were allowed to recover after CPB and underwent daily neurobehavioral evaluation by the neurological deficit score (NDS: 0, normal; 500, brain death) and overall performance categories (OPC: 1, normal; 5, brain death). Blood samples were drawn on postoperative day (POD) 1 for selected biochemistry analysis. On POD 4, the brain of each animal was perfusion-fixed for histological evaluation, and a neurohistological score (NHS: 0, normal; 5+, necrosis) was assigned for the degree of neuronal injury. All animals except one from group HTS survived surgery. Mean perfusion pressures were significantly elevated in group B compared with group C and group HTS during the rewarming phase (P < .05). The HbO2 signal increased in all groups during the cooling phase of CPB and remained significantly above baseline only in group B during DHCA (P < .05). SGOT, LDH, ALP, and CPK levels on POD 1 were elevated above baseline in all groups. The increase in SGOT and ALP was significantly greater in group HTS than in the other groups (P < .02). The NDS was lower in group B on each postoperative evaluation, being significant relative to group C and group HTS on POD 1 (P < .05) and significantly lower than group C on POD 2 (P < .05). The OPC score was significantly lower in group B than in group C and group HTS on POD 2 (P < .05) and significantly lower than in group C on PODs 3 and 4 (P < .05). The NHS was lower in group B than in the other 2 groups, being significant relative to group C in the neocortex (P < .007). Intermittent whole-body asanguineous perfusion with hypothermosol solution does not extend cerebral protection in a porcine survivor model of DHCA. Neurobehavioral and histological outcomes are improved in animals receiving intermittent blood perfusion during prolonged DHCA.