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Eur J Cardiothorac Surg 2004;26:571-579
© 2004 Elsevier Science NL

Differential brain and body temperature during cardiopulmonary bypass—a randomised clinical study

Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital NHS Trust, Birmingham, B15 2TH, UK

Received 29 October 2003; received in revised form 17 April 2004; accepted 26 May 2004.

^* Corresponding author. Tel.: +44-121-627-2543; fax: +44-121-627-2542
e-mail: robert.bonser{at}uhb.nhs.uk

Objective: Maintenance of normothermia during cardiopulmonary bypass (CPB) may have advantages over hypothermia but there is a potential increased hazard of neurological injury. A novel aortic cannula (Cobra^TM catheter, Cardeon^® Corp., Cupertino, CA, USA) which compartmentalises the aorta may allow simultaneous brain cooling during maintained corporeal normothermia. We investigated the thermal efficacy of this technique. Methods: We randomized 60 adult patients to normothermic CPB (n=30, temp=35 °C) or to differential temperature management (Cobra^TM cannula). Nasopharyngeal (NPT) and jugular bulb (JB) temperatures were used as surrogates for brain temperature while bladder temperature (BLT) represented the body (corporeal) temperature. Brain (radial) and corporeal (femoral) mean arterial pressure (MAP) together with jugular bulb and mixed venous saturations were monitored to assess perfusion adequacy. Transcranial Doppler was used to assess high intensity transient signals (HITS). All patients had neuropsychometric assessment pre-operatively and at 1 and 8 weeks post-operatively. Results: Demographic and CPB variables were comparable. A 3.2±0.46 °C differential between BLT and NPT was reached in all Cobra patients after 5.5±3.6 min (P<0.001). A 5 °C differential was reached in 29 patients after 12±7.5 min. The mean difference was 6.6±1 °C. MAP was maintained above 50 mmHg and venous saturations above 60% in both groups throughout. Blood requirements, extubation time and ITU stay were no different. Embolic counts and neuropsychometric outcomes were not different between groups. Conclusions: Differential temperature management using the Cobra^TM aortic catheter is possible. Further studies are necessary to establish whether the hypothesized advantages of combining corporeal normothermia with brain hypothermia can be realised.

Key Words: Cardiopulmonary bypass • Neuroprotection • Segmentation of aorta