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Eur J Cardiothorac Surg 2001;20:803-810
© 2001 Elsevier Science NL
a Department of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, University of Oulu, 90221 Oulu, Finland
b Department of Anesthesiology, Oulu University Hospital, University of Oulu, 90221 Oulu, Finland
Received 11 June 2001; received in revised form 26 July 2001; accepted 30 July 2001.
Corresponding author. Tel.: +358-8-3152-011; fax: +358-8-3152-577
e-mail: tatu.juvonen{at}oulu.fi
Objective: Beside neurological morbidity, mortality is a relevant end-point of experimental porcine model of hypothermic circulatory arrest (HCA) and this study was conducted to identify the determinants for postoperative death. Methods: One hundred and thirty-five pigs underwent a 75-min period of HCA at 20°C to evaluate the efficacy of different methods of cerebral protection. Results: Survival rate at 7-day follow-up was 52%. Lower oxygen extraction, oxygen consumption/kg, and venous lactate at the end of cooling and higher oxygen delivery rates were significantly associated with better outcome. Logistic regression showed that the oxygen consumption/kg at the end of cooling was the only predictor of mortality (P=0.046). Animals with an oxygen consumption/kg rate less than 1.43 ml/min per kg at the end of cooling had a mortality rate of 28%, whereas it was 50% among animals with an oxygen consumption/kg rate higher or equal to 1.43 ml/min per kg (P=0.020). The latter had even an increased 1-day mortality rate (40% vs. 26%) (P not significant). The mortality rate after anesthesia induction with ketamine plus 100% of oxygen was 38%, 45% after anesthesia induction with ketamine plus 35% oxygen, and 53% after anesthesia with medetomidine plus 35% oxygen (P not significant). Conclusions: Parameters of oxyhemodynamics should be monitored especially from the induction of anesthesia to the end of cooling before a 75-min period of HCA. The use of medetomidine and/or 35% of oxygen at induction of anesthesia should be avoided in favor of ketamine plus 100% of oxygen.
Key Words: Hypothermic circulatory arrest • Neuroprotection • Oxygen extraction • Oxygen consumption • Oxygen delivery • Oxygen saturation
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