Cerebral physiology of cardiac surgical patients treated with the perfluorocarbon emulsion, AF0144.
BACKGROUND
Perfluorooctyl bromide is a biologically inert compound with short biologic retention and high oxygen solubility. The purpose of this study was to assess the effect of the perfluorocarbon emulsion, AF0144 (Perflubron, Alliance Pharmaceutical Corp, San Diego, CA), used in conjunction with acute normovolemic hemodilution on cerebral blood flow and cerebral emboli measurements during coronary artery bypass grafting with cardiopulmonary bypass.


METHODS
Thirty-six adult cardiac surgical patients were enrolled in a single-institution, randomized, controlled, single-blind dose escalation trial. Autologous whole blood was harvested from each patient to target an on-bypass hematocrit of 20% to 22%. Placebo, low dose (1.8 g/kg) or high dose (2.7 g/kg) AF0144 was administered. Transcranial Doppler ultrasonography was used to quantitate cerebral emboli and xenon-133 clearance was used to measure cerebral blood flow.


RESULTS
Cerebral blood flow was increased in both AF0144-treated groups compared with placebo (p = 0.006, low dose vs control; p = 0.036, high dose vs control). Numbers of cerebral emboli were greater in the high-dose AF0144-treated group versus control during the time periods from aortic cannulation through aortic cross-clamp placement (p = 0.026) and from aortic cross-clamp placement through cross-clamp removal (p = 0.008).


CONCLUSIONS
The perfluorocarbon emulsion, AF0144, increased cerebral blood flow during cardiopulmonary bypass. In addition, total cerebral emboli load during bypass was greater in patients receiving high-dose AF0144.
Hill
Steven E
SE
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. hill0012@mc.duke.edu
Grocott
Hilary P
HP
Leone
Bruce J
BJ
White
William D
WD
Newman
Mark F
MF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D006842:Hydrocarbons, Brominated; D020766:Intracranial Embolism / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D014463:Ultrasonography
D005466:Fluorocarbons; D006842:Hydrocarbons, Brominated; C003072:perflubron