title: A Clinical Protocol for Goal Directed Cerebral Perfusion during Aortic Arch Surgery.
abstract: OBJECTIVE
  The optimal strategy to deliver antegrade cerebral perfusion for cerebral protection during hypothermic circulatory arrest has not been established. The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience.
  Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP). Other published techniques favored antegrade cerebral perfusion but were limited by smaller cannulae, multiple cannulation sites, and lower cooling temperatures.
  
  
  CONCLUSIONS
  Our clinical protocol may offer higher flow rates, avoid complications associated with additional cannulae, and provide an easy setup for dual arterial perfusion. Additionally, GDP has enhanced our understanding of metabolic physiology and may facilitate the development of a better cerebral protection strategy.
authors.affiliation: University of Colorado Hospital, Aurora, CO, USA Matthew.Mosca@uchealth.org.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Mosca
authors.affiliation: University of Colorado Hospital, Aurora, CO, USA.
authors.forename: George
authors.initials: G
authors.lastname: Justison
authors.affiliation: University of Colorado Denver, Denver, CO, USA.
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
mesh_terms: D000758:Anesthesia; D001013:Aorta, Thoracic / Q000601:surgery*; D002245:Carbon Dioxide / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D002985:Clinical Protocols; D006801:Humans; D016343:Monitoring, Intraoperative; D010101:Oxygen Consumption
chemical_list: D002245:Carbon Dioxide
keywords: aortic arch surgery; cerebral protection; goal-directed perfusion; innominate artery; selective antegrade cerebral perfusion