title: Perfluorocarbons are effective oxygen carriers in cardiopulmonary bypass.
abstract: Intravascular perfluorochemical (PFC) emulsions together with a high oxygen (O2) tension may increase the delivery of dissolved O2 to useful levels. A severely anemic model of cardiopulmonary bypass (CPB) was used to test the hypothesis that a novel PFC emulsion (PFCE; Oxygent [Alliance Pharmaceutical Corp., San Diego, CA] 90% w/v perflubron) used at a high PO2 during bypass delivers sufficient O2 to ameliorate hypoxic myocardial contractile dysfunction. Acutely anemic dogs (N = 42; hematocrit = 15.8 +/- 0.6% [mean +/- SEM] before CPB and 10.9 +/- 0.1% during CPB) were divided into four groups. Group 1 was a control (n = 12). As CPB was initiated, groups 2 (n = 10), 3 (n = 10), and 4 (n = 10) had 1.35 g PFC.kg-1, 2.7 g PFC.kg-1, or 5.4 g PFC.kg-1 added via the venous return cannula. Pre-CPB and post-CPB cardiac function was measured by the first derivative of left ventricular pressure (dP/dtmax). The dP/dtmax on separation from CPB was: group 1, 619 +/- 96; group 2, 738 +/- 56; group 3, 782 +/- 101; and group 4, 828 +/- 100 (p < 0.05 groups 3 and 4 versus group 1). Mortality during the first hour after separation from CPB was higher in group 1 than in PFCE treated dogs; however, this trend did not attain statistical significance (p < 0.065). The PFC dose was higher in survivors than in nonsurvivors (2.6 +/- 0.4 g PFC.kg-1 versus 1.2 +/- 0.5 g PFC.kg-1; p < 0.05). A PFCE used at a high PO2 provides sufficient physically dissolved O2 to relieve myocardial hypoxic injury in a severely anemic model of CPB. Current PFCEs are effective O2 carriers. This finding suggests that they can be used as a temporary erythrocyte substitute to diminish the need for allogeneic transfusions during cardiac operations.
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham 35294, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Spruell
authors.forename: E R
authors.initials: ER
authors.lastname: Ferguson
authors.forename: J J
authors.initials: JJ
authors.lastname: Clymer
authors.forename: W V
authors.initials: WV
authors.lastname: Vicente
authors.forename: C P
authors.initials: CP
authors.lastname: Murrah
authors.forename: W L
authors.initials: WL
authors.lastname: Holman
mesh_terms: D000740:Anemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D001802:Blood Substitutes; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004285:Dogs; D004655:Emulsions; D005069:Evaluation Studies as Topic; D005466:Fluorocarbons; D006400:Hematocrit; D006842:Hydrocarbons, Brominated; D009200:Myocardial Contraction; D010100:Oxygen / Q000097:blood*
chemical_list: D001802:Blood Substitutes; D004655:Emulsions; D005466:Fluorocarbons; D006842:Hydrocarbons, Brominated; C003072:perflubron; D010100:Oxygen