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Assessment of dynamic cerebral autoregulation and cerebral carbon dioxide reactivity during normothermic cardiopulmonary bypass

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Abstract

Despite increased risk of neurological complications after cardiac surgery, monitoring of cerebral hemodynamics during cardiopulmonary bypass (CPB) is still not a common practice. Therefore, a technique to evaluate dynamic cerebral autoregulation and cerebral carbon dioxide reactivity (CO2R) during normothermic nonpulsatile CPB is presented. The technique uses continuous recording of invasive arterial blood pressure, middle cerebral artery blood flow velocity, absolute cerebral tissue oxygenation, in-line arterial carbon dioxide levels, and pump flow measurement in 37 adult male patients undergoing elective CPB. Cerebral autoregulation is estimated by transfer function analysis and the autoregulation index, based on the response to blood pressure variation induced by cyclic 6/min changes of indexed pump flow from 2.0 to 2.4 up to 2.8 L/min/m2. CO2R was calculated from recordings of both cerebral blood flow velocity and cerebral tissue oxygenation. Cerebral autoregulation and CO2R were estimated at hypocapnia, normocapnia, and hypercapnia. CO2R was preserved during CPB, but significantly lower for hypocapnia compared with hypercapnia (p < 0.01). Conversely, cerebral autoregulation parameters such as gain, phase, and autoregulation index were significantly higher (p < 0.01) during hypocapnia compared with both normocapnia and hypercapnia. Assessing cerebral autoregulation and CO2R during CPB, by cyclic alteration of pump flow, showed an impaired cerebral autoregulation during hypercapnia.

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Acknowledgments

The authors thank Prof. R.B. Panerai (University of Leicester, UK) and Dr. A.S. Sharma (Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht - CARIM, Maastricht, the Netherlands) for their valuable contributions to the manuscript.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, PO box 5800, 6202 AZ, Maastricht, The Netherlands

    Ervin E. Ševerdija, Patrick W. Weerwind & Jos G. Maessen

  2. Cardiovascular Research Institute Maastricht - CARIM, Maastricht, The Netherlands

    Ervin E. Ševerdija, Patrick W. Weerwind & Jos G. Maessen

  3. Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Erik D. Gommer, Jos P. H. Reulen & Werner H. Mess

Authors
  1. Ervin E. Ševerdija
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  2. Erik D. Gommer
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  3. Patrick W. Weerwind
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  4. Jos P. H. Reulen
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  5. Werner H. Mess
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  6. Jos G. Maessen
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Correspondence to Ervin E. Ševerdija.

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Ševerdija, E.E., Gommer, E.D., Weerwind, P.W. et al. Assessment of dynamic cerebral autoregulation and cerebral carbon dioxide reactivity during normothermic cardiopulmonary bypass. Med Biol Eng Comput 53, 195–203 (2015). https://doi.org/10.1007/s11517-014-1225-z

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  • DOI: https://doi.org/10.1007/s11517-014-1225-z

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