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CARDIOVASCULAR ANESTHESIA

A Comparison of Complete Blood Replacement With Varying Hematocrit Levels on Neurological Recovery in a Porcine Model of Profound Hypothermic (<5°C) Circulatory Arrest

Palaniandy Sekaran, MD^*, Marek Ehrlich, MD, Christian Hagl, MD, Marc L. Leavitt, PhD, Roger Jacobs, PhD, Jock N. McCullough, MD, and Elliott Bennett-Guerrero, MD^*

Departments of *Anesthesiology and Cardiac Surgery, The Mount Sinai School of Medicine, New York, New York, and BioTime Inc., Berkeley, California

Address correspondence and reprint requests to Elliott Bennett-Guerrero, MD, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 W. 168^th Street (PH5–505), New York, NY 10032–3784. Address e-mail to eb413{at}columbia.edu

Profound hypothermia (<5°C) may afford better neurological protection after circulatory arrest; however, there are theoretical concerns related to microcirculatory sludging of blood components at these ultra-low temperatures. We hypothesized that at temperatures <5°C, complete blood replacement results in superior neurological outcome. Twelve Yorkshire pigs (30 kg) underwent thoracotomy, cardiopulmonary bypass (CPB), and were randomly assigned to one of three target hematocrits during circulatory arrest: 0%, 5%, 15%. Hextend^® (6% hetastarch in a balanced electrolyte vehicle) was used for the CPB prime and as an exchange fluid. Animals were cooled to a temperature <5°C, underwent 1-h circulatory arrest, and were warmed to 35°C with administration of blood to increase the hematocrit to >25% before separation from CPB. The primary outcome, peak postoperative neurobehavioral score, was compared between groups. The 0% group (mean ± SD) had significantly (P < 0.02) better neurobehavioral scores than the 5% and 15% groups (6.0 ± 2.9 vs 1.3 ± 1.0 and 1.5 ± 0.6) respectively. Other variables (e.g., intracranial pressure) were similar between groups. In a porcine model of profound hypothermia (<5°C) and circulatory arrest, complete blood replacement resulted in superior neurological outcome. This finding suggests that at ultralow temperatures, the presence of some blood component (e.g., erythrocytes, leukocytes) may be deleterious.

Implications: In a porcine model of profound hypothermia (<5°C) and circulatory arrest, complete blood replacement resulted in superior neurological outcome. This finding suggests that at ultralow temperatures, the presence of erythrocytes or some other blood component may be deleterious.

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