title: Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass.
abstract: Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO2) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n = 77) or nonpulsatile (n = 34) perfusion. No significant differences in demographic and intraoperative data, including surgical risk stratification, existed between groups. Patients undergoing pulsatile perfusion had numerically lower decreases in rSO2 from baseline for all time points analyzed compared with the nonpulsatile group, with significant ∼12% lower decreases at 40 and 60 min after crossclamp. Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ∼30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes.
authors.affiliation: Department of Pediatrics, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania 17033, USA.
authors.forename: Xiaowei W
authors.initials: XW
authors.lastname: Su
authors.forename: Yulong
authors.initials: Y
authors.lastname: Guan
authors.forename: Mollie
authors.initials: M
authors.lastname: Barnes
authors.forename: J Brian
authors.initials: JB
authors.lastname: Clark
authors.forename: John L
authors.initials: JL
authors.lastname: Myers
authors.forename: Akif
authors.initials: A
authors.lastname: Undar
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D054022:Cerebrum / Q000098:blood supply* / Q000378:metabolism*; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010100:Oxygen / Q000378:metabolism*; D011673:Pulsatile Flow / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D018709:Statistics, Nonparametric; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods
chemical_list: D010100:Oxygen