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The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 658-664, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LS Fox, EH Blackstone, JW Kirklin, SP Bishop, LA Bergdahl and EL Bradley
A study was made of the relation of brain blood flow and oxygen consumption
to changes in perfusion flow rate during cardiopulmonary bypass at 20
degrees C in nine cynomolgus monkeys. Four perfusion flow rates varying
from 0.25 to 1.75 L X min-1 X m-2 were randomly instituted, each for a 10
minute period. At the end of each period, brain arteriovenous oxygen
content difference was measured and 15 mu radioactive microspheres were
injected into the arterial perfusion line. The brain was then removed and
section into anatomic regions and radioactivity was counted. Regional and
total brain blood flows were calculated, as was whole brain oxygen
consumption. Brain perfusion continued in all areas at all perfusion flow
rates. Whole brain blood flow decreased (p less than 0.0001) as perfusion
flow rate was reduced (45 +/- 6.5, 41 +/- 7.9, and 23 +/- 2.8 ml X min-1 X
100 gm-1 at 1.5, 1.0, and 0.5 L X min-1 X m-2, respectively). The
proportion of the total perfusion delivered to the brain increased (p =
0.003) with decreasing perfusion flow rates (5.4% +/- 0.78%, 7.1% +/-
1.24%, and 8.2% +/- 1.11% at 1.5, 1.0, and 0.5 L X min-1 X m-2,
respectively). Brain blood flow resistance remained unchanged (p = 0.4)
while that of the remaining body increased (p less than 0.0001). There was
a greater reduction of blood flow in the cortical white matter (p = 0.01)
than in other regions of the brain. Brain oxygen consumption was the same
(p = 0.5) at all perfusion flow rates, related to an increasing percent
oxygen extraction with decreasing perfusion flow rate (p less than 0.0001).
The data indicate that all areas of the brain remain perfused, even at low
perfusion flow rates, during profoundly hypothermic cardiopulmonary bypass,
and that brain oxygen consumption is maintained in part by increased oxygen
extraction and in part by redistribution of the perfusate from the
remaining body to the brain.
ARTICLES
Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. An experimental study
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