Cardiac surgery utilizing circulatory arrest is most commonly performed under deep
hypothermia (∼18°C) to suppress tissue oxygen demand and provide neuroprotection during
operative circulatory arrest. Studies investigating the effects of deep hypothermic
circulatory arrest (DHCA) on neurodevelopmental outcomes of patients with congenital
heart disease give conflicting results. Here, we address these issues by quantifying
changes in cerebral oxygen saturation, blood flow, and oxygen metabolism in neonates
during DHCA and investigating the association of these changes with postoperative
brain injury. Neonates with critical congenital heart disease undergoing DHCA were
recruited for continuous intraoperative monitoring of cerebral oxygen saturation (ScO2) and an index of cerebral blood flow (CBFi) using 2 noninvasive optical techniques, diffuse optical spectroscopy (DOS) and diffuse
correlation spectroscopy (DCS). Pre- and postoperative brain magnetic resonance imaging
(MRI) was performed to detect white matter injury (WMI). Fifteen neonates were studied,
and 11/15 underwent brain MRI. During DHCA, ScO2 decreased exponentially in time with a median decay rate of -0.04 min−1. This decay rate was highly variable between subjects. Subjects who had larger decreases
in ScO2 during DHCA were more likely to have postoperative WMI (P = 0.02). Cerebral oxygen extraction persists during DHCA and varies widely from patient-to-patient.
Patients with a higher degree of oxygen extraction during DHCA were more likely to
show new WMI in postoperative MRI. These findings suggest cerebral oxygen extraction
should be monitored during DHCA to identify patients at risk for hypoxic-ischemic
injury, and that current commercial cerebral oximeters may underestimate cerebral
oxygen extraction.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
CBFi (cerebral blood flow index), CBF (cerebral blood flow), CBV (cerebral blood volume), CHD (congenital heart disease/defect), CICU (cardiac intensive care unit), CHOP (The Children's Hospital of Philadelphia), CMRO2 (cerebral metabolic rate of oxygen), CW-NIRS (continuous-wave near infrared spectroscopy), DCS (diffuse correlation spectroscopy), FD-DOS (frequency-domain diffuse optical spectroscopy), FD-NIRS (frequency-domain near infrared spectroscopy), Hb (deoxyhemoglobin, measured with DOS), HbO2 (oxyhemoglobin, measured with DOS), Hct (hematocrit, measured from blood gas), Hgb (hemoglobin, measured from blood gas), HLHS (hypoplastic left heart syndrome), IQR (interquartile range), OEF (cerebral oxygen extraction fraction), SpO2 (peripheral capillary oxygen saturation), ScO2 (cerebral tissue oxygen saturation), WMI (white matter injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 08, 2021
Footnotes
All procedures were approved by the Institutional Review Board (11-008191, initially approved August 08, 2011).
Parents were approached for consent after birth and prior to day of surgery.
Funding sources: This study was supported by the NIH Grant Nos. NS-072338, NS-060653, HL-007954, HL-007915, P41-EB015893, the Thrasher Research Foundation, and the June and Steve Wolfson Family foundation.
Conflicts of Interest: Arjun G. Yodh has his name is on four patents submitted on behalf of the Trustees of the University of Pennsylvania related to this work: US20190000321, US10064554, US20140343384, US8082015 but does not generate income.
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