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Unclamping the inferior vena cava during retrograde cerebral perfusion increases the safe range of retrograde perfusion pressures and improves brain perfusion

^a Departments of Biochemistry and Medical Genetics and Surgery, University of Manitoba, Winnipeg, Man., Canada
^b Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Avenue, Winnipeg, Man., Canada R3B 1Y6
^c Zhejiang University, Hangzhou, China

^* Corresponding author. Address: Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Avenue, Winnipeg, Man., Canada R3B 1Y6. Tel.: +1-204-984-7037; fax: +1-204-984-7036
jian.ye{at}nrc-cnrc.gc.ca

We investigated the effect of different methods of management of the inferior vena cava (IVC) during retrograde cerebral perfusion (RCP) on the relationships between RCP pressure, regional cerebral blood flow, tissue oxygenation, and intracranial pressure (ICP). Fourteen pigs were subjected to hypothermic (15 °C) RCP at RCP pressures varying from 10 to 110 mmHg with clamping (closed group, ) or without clamping of the IVC (open group, ). Intracranial pressures increased more slowly in the open group than in the closed group and were significantly lower at any level of RCP pressure in the open group than in the closed group. In the closed group, RCP pressures of 20–30 mmHg resulted in an ICP of 25 mmHg. In contrast, in the open group, when RCP pressures were maintained below 70 mmHg, ICP never reached 25 mmHg. Brain tissue blood flow and CO₂ production were relatively higher in the open group than in the closed group. The maximum brain tissue blood flow was achieved at an RCP pressure of 40 mmHg in the open group. We conclude that the maximum safe RCP pressure differs according to the type of management of the IVC. Opening the IVC during RCP not only improves brain tissue perfusion, but also significantly increases the safety margin of RCP pressures. In the pig model, when the IVC is not clamped, the optimal RCP pressure appears to be 40 mmHg.

Key Words: Retrograde cerebral perfusion; Circulatory arrest; Intracranial pressure; Cerebral blood flow; Near-infrared spectroscopy

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