Brain damage after profoundly hypothermic circulatory arrest: correlations between neurophysiologic and neuropathologic findings. An experimental study in vertebrates.
Five groups of neonatal pigs were subjected to cardiopulmonary bypass with circulatory arrest periods that varied from 70 to 120 minutes for the investigation of brain changes in induced deep-core hypothermia (15 degrees C) with circulatory arrest. The parameters that were analyzed were (1) microscopy of the brain in animals at 6 hours after bypass procedures and (2) intraoperative monitoring of somatosensory evoked potentials. Microscopic cellular damage appeared in all animals with a circulatory arrest period of more than 70 minutes. These changes involved mainly Purkinje's cells of the cerebellum, and they affected particularly the inferior half of the cerebellum. The prolongation of latency in the cortical responses, which reflects a slowing of the neural transmission with hypothermia, occurred in all animals. The late evoked potentials remained absent in all piglets with circulatory arrest periods of 90, 105, and 120 minutes, but they were fully recovered in all piglets of the control group and those with 70-minute arrest times. We concluded that the cerebellar region is the most sensitive site in which ischemic lesions attain their maximal severity and extent, and the maximum time of circulatory arrest without histopathologic and neurophysiologic sequelae should not exceed 70 minutes.
Fessatidis
I T
IT
Department of Wessex Cardiothoracic Surgery, Southampton General Hospital, University of Southampton, United Kingdom.
Thomas
V L
VL
Shore
D F
DF
Sedgwick
M E
ME
Hunt
R H
RH
Weller
R O
RO
D000818:Animals; D000831:Animals, Newborn; D001921:Brain / Q000473:pathology* / Q000503:physiopathology* / Q000648:ultrastructure; D001925:Brain Damage, Chronic / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005073:Evoked Potentials, Somatosensory; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008854:Microscopy, Electron; D016343:Monitoring, Intraoperative; D013552:Swine; D013997:Time Factors