Neonatal brain protection and deep hypothermic circulatory arrest: pathophysiology of ischemic neuronal injury and protective strategies.
Deep hypothermic circulatory arrest (DHCA) has been used for the past 50 years in the surgical repair of complex congenital cardiac malformations and operations involving the aortic arch; it enables the surgeon to achieve precise anatomical reconstructions by creating a bloodless operative field. Nevertheless, DHCA has been associated with immediate and late neurodevelopmental morbidities. This review provides an overview of the pathophysiology of neonatal hypoxic brain injury after DHCA, focusing on cellular mechanisms of necrosis, apoptosis, and glutamate excitotoxicity. Techniques and strategies in neonatal brain protection include hypothermia, acid base blood gas management during cooling, and pharmacologic interventions such as the use of volatile anesthetics. Surgical techniques consist of intermittent cerebral perfusion during periods of circulatory arrest and continuous regional brain perfusion.
Amir
Gabriel
G
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California 94305, USA. gabiamir@stanford.edu
Ramamoorthy
Chandra
C
Riemer
R Kirk
RK
Reddy
V Mohan
VM
Hanley
Frank L
FL
D000328:Adult; D000818:Animals; D016923:Cell Death; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects* / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn