Aprotinin to improve cerebral outcome after hypothermic circulatory arrest: a study in a surviving porcine model.
BACKGROUND
Aprotinin is a serine protease inhibitor, which is usually used during cardiac surgery to reduce blood loss. There is evidence that aprotinin has neuroprotective effects during ischemia. We planned this study to evaluate its potential neuroprotective efficacy during hypothermic circulatory arrest (HCA).


METHODS
Twenty piglets with a median weight of 25.7 kg (interquartile range, 23.9-26.6) were randomly assigned to receive aprotinin or placebo prior to a 75-minute period of HCA at 18 degrees C. Brain microdialysis parameters and neurological and histological scores were the primary outcome measures.


RESULTS
Changes in brain metabolic parameters and histopathological findings were favorable in the aprotinin group. Brain lactate concentrations were significantly lower in the aprotinin group during the experiment (P = .02) along with blood lactate concentrations in the aprotinin group (P = .023). Brain glucose was significantly higher during the experiment (P = 0.02). Intracranial pressure tended to be higher in the control group. Two of 10 animals in the aprotinin group and 4 of 10 in the control group failed to reach full recovery on the seventh postoperative day. Four animals of 10 in the aprotinin group and 6 animals of 10 in the control group had brain infarction (P = .40).


CONCLUSIONS
The present data suggest that aprotinin mitigates cerebral damage and improves neurological outcome following a period of HCA.
Heikkinen
Janne
J
Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland.
Kaakinen
Timo
T
Dahlbacka
Sebastian
S
Kiviluoma
Kai
K
Salomäki
Timo
T
Laurila
Päivi
P
Biancari
Fausto
F
Tuominen
Hannu
H
Anttila
Vesa
V
Juvonen
Tatu
T
D000818:Animals; D007611:Aprotinin / Q000008:administration & dosage*; D001928:Brain Diseases, Metabolic / Q000139:chemically induced* / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000209:etiology* / Q000517:prevention & control*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D018696:Neuroprotective Agents / Q000008:administration & dosage; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage; D013552:Swine; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D015842:Serine Proteinase Inhibitors; D007611:Aprotinin