Cerebral Metabolism and Function during Normothermic Retrograde Cerebral Perfusion

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Abstract
Retrograde cerebral perfusion through a superior vena cava (SVC) cannula is a new technique used to protect the brain during circulatory arrest. Cerebral blood flow, oxygen consumption, blood sugar consumption and auditory brain stem responses were measured at various rates (100, 200 and 300 ml min−1) of retrograde cerebral perfusion in normothermic mongrel dogs ( n = 12, body-weight 13–15 kg). During perfusion about 20% of the perfusate from the SVC was returned via the aorta, while the rest drained into the inferior vena cava. External jugular venous pressure increased as the perfusion rate increased (mean(s.d.) 26.0(6.4) mmHg at a rate of perfusion of 300 ml min−1). Oxygen and blood sugar consumption also increased as the rate of perfusion increased. Retrograde cerebral perfusion at 300 ml min−1 provided half of the cerebral blood flow (mean(s.d.) 14.7(6.4) versus 34.3(7.8)ml min−1) of antegrade cardiopulmonary bypass (CPB). Analysis of the blood returned through the aorta during perfusion at a rate of 300 ml min−1 showed that mean(s.d.) oxygen consumption was about one-third (4.4(2.1) versus 12.3(7.1) ml min−1) and blood sugar consumption about 15% (17(22) versus 114(54) mg min−1) of that seen in blood returned through the SVC during CPB. Auditory brain stem responses disappeared immediately when perfusion was started but recovered completely as soon as CPB was resumed. Although the oxygen provided by perfusion was not sufficient to maintain cerebral function, it should help protect the brain during circulatory arrest.