Effectiveness of the Cobra aortic catheter for dual-temperature management during adult cardiac surgery.
OBJECTIVE
In animals the Cardeon Cobra catheter (Cardeon Corp, Cupertino, Calif) allows independent control of aortic arch and descending aortic temperatures and profoundly reduces cerebral embolization during bypass. This investigation describes the first clinical use of the device during adult cardiac surgery. The purpose of the study was to confirm that the Cobra catheter delivers adequate cerebral and systemic perfusion while providing simultaneous cerebral hypothermia and systemic normothermia during cardiopulmonary bypass.


METHODS
In a prospective multicenter study the Cobra aortic catheter was placed in 20 adults undergoing cardiopulmonary bypass. Arch and corporeal temperatures, bypass flows, and arterial blood pressures were recorded intraoperatively. Jugular bulb and mixed venous oxygen saturation was used to assess the adequacy of cerebral and systemic perfusion.


RESULTS
Surgeons at 3 institutions placed the Cobra catheter in patients undergoing coronary artery bypass grafting (n = 13), valve (n = 3), and combined valve-bypass (n = 4) operations. Mean total bypass flows of 2.1 +/- 0.2 L x min(-1) x m(-2) maintained mean arterial pressures in arch and descending aortic circulations of greater than 55 mm Hg. A mean differential of 4.3 degrees C between arch and descending aortic temperatures was established before crossclamp application, and a mean maximum temperature differential of 7 degrees C was established during bypass. A 2.4 degrees C temperature differential was maintained at crossclamp removal. Cerebral and systemic venous oxygen saturation remained greater than 65% during bypass.


CONCLUSIONS
The Cobra device met all expectations for an arterial cannula with adequate perfusion to the arch and corporeal circulations. Dual perfusion with the Cobra catheter allows for independent temperature control during cardiopulmonary bypass with simultaneous cerebral hypothermia and systemic normothermia.
Cook
D J
DJ
Department of Anesthesiology and Division of Cardiothoracic Surgery, Mayo Clinic and Foundation, Rochester, MN 55905, USA. cook.david@mayo.edu
Orszulak
T A
TA
Zehr
K J
KJ
Nussmeier
N A
NA
Livesay
J J
JJ
Hammon
J W
JW
Chen
X
X
D000328:Adult; D000368:Aged; D000818:Animals; D001013:Aorta, Thoracic / Q000502:physiology; D001784:Blood Gas Analysis; D001831:Body Temperature; D001833:Body Temperature Regulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000592:standards*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000145:classification / Q000601:surgery; D004195:Disease Models, Animal; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation*; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D007601:Jugular Veins / Q000502:physiology; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011446:Prospective Studies; D012720:Severity of Illness Index; D001743:Urinary Bladder / Q000502:physiology