By Peter L. Steponkus
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Extra resources for Advances in Low-Temperature Biology, Volume 3
THE ALLEGHENY APPROACH TO ULTRAPROFOUND HYPOTHERMIA AND BLOOD SUBSTITUTION It is clear from the preceding discussion that the feasibility of extending the present clinical limits of circulatory and/or cardiac arrest for bloodless surgery without incurring unacceptable or irreversible ischemic changes is positively indicated from both scientific considerations and the historical background for the application of hypothermia to total body preservation. Nevertheless, while a variety of experimental techniques have been explored, none has justified clinical consideration since the risk of complications remains too high after periods of arrest approaching 90 to 120 minutes.
Serum enzymes that reflect the functional integrity of vital organs such as heart, liver, and brain were measured as indicators of general tissue preservation during the hypothermic whole-body perfusion technique. These data supplement the ultimate assay of life-supporting function demonstrated in these long-term surviving animals. , 1995). In general. Group I survivors showed only inconsequential and transient elevations in the measured enzymes compared with the marked and more persistent rises seen in the surviving dogs from Group II.
Neurological integrity and complete physiological recovery following such an invasive procedure must rely upon adequate perfusion of the preservation solutions to vital tissues during the cold-ischemic interval. The brain, in particular, will rapidly succumb to ischemic injury if perfusion is inadequate. The interdependence of cerebral perfusion pressure and cerebral blood flow after cardiac arrest has been implicated as a major contributory factor in clinical cases where there are neurological sequelae following cardiopulmonary bypass and hypothermia.
Advances in Low-Temperature Biology, Volume 3 by Peter L. Steponkus