Observations during hypervolemic hemodilution of patients with acute focal cerebral ischemia

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Abstract
Infusions of 5% albumin and/or dextran 40 in 9 patients with acute ischemic neurological deficits reduced mean hematocrit values from 41 to 32%, raised mean central venous pressure from 4 to 12 cm H2O and reduced mean arterial BP from 101 to 94 mm Hg. Six alert patients had ischemic structural damage on cranial computed tomography. All 6 alert patients with upper arm paresis objectively improved and 2 others with only dysphasia also improved within 24 h after infusion initiation. Although the improvement in 2 patients seemed to be temporarily dependent on the continuing of the infusion, all 8 alert patients were eventually weaned without loss of regained function. Augmentation of collateral perfusion secondary to reduced blood viscosity may rapidly relieve cerebral ischemia, impede infarction and allow time for compensatory mechanisms to maintain blood flow above ischemic thresholds.