Non-invasive optical neuromonitoring of the temperature-dependence of cerebral oxygen metabolism during deep hypothermic cardiopulmonary bypass in neonatal swine

Tiffany S. Ko, Constantine D. Mavroudis, Wesley B. Baker, Vincent C. Morano, Kobina Mensah-Brown, Timothy W. Boorady, Alexander L. Schmidt, Jennifer M. Lynch, David R. Busch, Javier Gentile, George Bratinov, Yuxi Lin, Sejin Jeong, Richard W. Melchior, Tami M. Rosenthal, Brandon C. Shade, Kellie L. Schiavo, Rui Xiao, J. William Gaynor, Arjun G. YodhTodd J. Kilbaugh, Daniel J. Licht

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Management of deep hypothermic (DH) cardiopulmonary bypass (CPB), a critical neuroprotective strategy, currently relies on non-invasive temperature to guide cerebral metabolic suppression during complex cardiac surgery in neonates. Considerable inter-subject variability in temperature response and residual metabolism may contribute to the persisting risk for postoperative neurological injury. To characterize and mitigate this variability, we assess the sufficiency of conventional nasopharyngeal temperature (NPT) guidance, and in the process, validate combined non-invasive frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for direct measurement of cerebral metabolic rate of oxygen (CMRO2). During CPB, n = 8 neonatal swine underwent cooling from normothermia to 18℃, sustained DH perfusion for 40 min, and then rewarming to simulate cardiac surgery. Continuous non-invasive and invasive measurements of intracranial temperature (ICT) and CMRO2 were acquired. Significant hysteresis (p < 0.001) between cooling and rewarming periods in the NPT versus ICT and NPT versus CMRO2 relationships were found. Resolution of this hysteresis in the ICT versus CMRO2 relationship identified a crucial insufficiency of conventional NPT guidance. Non-invasive CMRO2 temperature coefficients with respect to NPT (Q10 = 2.0) and ICT (Q10 = 2.5) are consistent with previous reports and provide further validation of FD-DOS/DCS CMRO2 monitoring during DH CPB to optimize management.

Original languageEnglish (US)
Pages (from-to)187-203
Number of pages17
JournalJournal of Cerebral Blood Flow and Metabolism
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • Cerebral oxygen metabolism
  • cardiopulmonary bypass
  • deep hypothermia
  • diffuse correlation spectroscopy
  • diffuse optical spectroscopy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    Ko, T. S., Mavroudis, C. D., Baker, W. B., Morano, V. C., Mensah-Brown, K., Boorady, T. W., Schmidt, A. L., Lynch, J. M., Busch, D. R., Gentile, J., Bratinov, G., Lin, Y., Jeong, S., Melchior, R. W., Rosenthal, T. M., Shade, B. C., Schiavo, K. L., Xiao, R., Gaynor, J. W., ... Licht, D. J. (2020). Non-invasive optical neuromonitoring of the temperature-dependence of cerebral oxygen metabolism during deep hypothermic cardiopulmonary bypass in neonatal swine. Journal of Cerebral Blood Flow and Metabolism, 40(1), 187-203. https://doi.org/10.1177/0271678X18809828