Balloon pump–induced pulsatile perfusion during cardiopulmonary bypass does not improve brain oxygenation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 118; no. 2; pp. 361 - 366
• Main Authors: Kawahara, Fuminori, Kadoi, Yuji, Saito, Shigeru, Yoshikawa, Daisuke, Goto, Fumio, Fujita, Nao
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.08.1999; AATS/WTSA; Elsevier
• Subjects: Aged; Biological and medical sciences; Brain - blood supply; Brain - metabolism; Brain Ischemia - metabolism; Brain Ischemia - physiopathology; Brain Ischemia - prevention & control; Cardiopulmonary Bypass - adverse effects; Cerebrovascular Circulation; Coronary Artery Bypass - adverse effects; Humans; Intra-Aortic Balloon Pumping; Intraoperative Complications - metabolism; Intraoperative Complications - prevention & control; Medical sciences; Middle Aged; Oximetry; Oxygen Consumption - physiology; Pulsatile Flow; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Human; Prognosis; Cuffed tube; Cardiopulmonary bypass; Treatment; Aortocoronary; Pumping; Bypass; Surgery; Anesthesia; Aorta; Intraarterial administration; Technique; Oxygenation; Brain (vertebrata)
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(99)70228-X

Background: Whether pulsatile flow offers substantial advantages for brain protection during cardiopulmonary bypass is controversial. The purpose of this study is to determine whether differences exist between pulsatile and nonpulsatile bypass concerning the effects on internal jugular venous saturation and on the state of regional cerebral oxygenation during normothermia. Methods: Twenty-two patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups: group 1 (n = 11) received nonpulsatile perfusion during cardiopulmonary bypass and group 2 (n = 11) received pulsatile perfusion during bypass. We used an intra-aortic balloon pump to generate pulsatility. A spectrophotometric probe (INVOS 3100R, Somanetics, Troy, Mich) was used to assess the state of regional cerebral oxygenation. A 4F fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to monitor jugular venous oxygen saturation. Hemodynamic variables, arterial and jugular venous blood gases, and regional cerebral oxygenation were measured at 7 times points. Results: In both groups, jugular venous oxygen saturation decreased at the early stage of the cardiopulmonary bypass ( P = .03). Five patients in group 1 and 6 in group 2 had a jugular venous oxygen saturation of less than 50%. In both groups, the regional cerebral oxygenation value decreased during cardiopulmonary bypass ( P = .04). Conclusions: The present results showed that pulsatility generated through the use of intra-aortic balloon pumping did not produce any beneficial effects on jugular venous oxygen saturation and regional cerebral oxygenation at normothermia. (J Thorac Cardiovasc Surg 1999;118:361-6)