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Ann Thorac Surg 2005;80:22-28
© 2005 The Society of Thoracic Surgeons
a Department of Anesthesiology, Cardiac Division, Ottawa, Ontario, Canada
b Department of Surgery, Division of Cardiac Surgery, Ottawa, Ontario, Canada
c Department of Epidemiology, University of Ottawa Heart Institute and Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Accepted for publication January 10, 2005.
* Address reprint requests to Dr Rodriguez, University of Ottawa Heart Institute, Room H-341, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada (Email: rrodriguez{at}ottawaheart.ca).
BACKGROUND: The intracranial hemodynamic effects of modified ultrafiltration in children are unknown. We investigated the effects of different blood flow rates during modified ultrafiltration on the cerebral hemodynamics of children with weights above and below 10 kg.
METHODS: Thirty-one children (weights: 
10 kg, n = 21; > 10 kg, n = 10) undergoing cardiopulmonary bypass were studied. Middle-cerebral artery blood flow velocities and cerebral mixed venous oxygen saturations were measured before, five minutes from the beginning, and at the end of ultrafiltration. Patients were classified according to their blood flow rates during ultrafiltration in three groups: high (
20 mL/kg/min), moderate (10–19 mL/kg/min), and low flow rates (< 10 mL/kg/min).
RESULTS: During modified ultrafiltration, blood pressures and hematocrit increased (p < 0.001), but cerebral blood flow velocities and mixed venous oxygen saturations decreased (p < 0.001). A significant correlation was found between blood flow rates of ultrafiltration and the decline in mean cerebral blood flow velocity (r = – 0.48; p = 0.005) and cerebral oxygen saturation (r = – 0.49; p = 0.005) or hematocrit increase (r = 0.59; p = 0.001). Infants exposed to high flow rates had greater reduction of cerebral blood flow velocity and regional mixed venous saturation and higher hematocrit at the end of ultrafiltration compared with those subjected to moderate and low flow rates (p < 0.04). No significant difference was found between moderate and low flow groups. The flow rate of ultrafiltration was the only independent predictor of the changes in cerebral mixed venous oxygen saturation (p = 0.033).
CONCLUSIONS: High blood flow rates through the ultrafilter during modified ultrafiltration transiently decrease the cerebral circulation in young infants compared with lower blood flow rates. These effects may be related to an increased diastolic runoff from the aorta into the ultrafiltration circuit that leads to a "stealing" effect from the intracranial circulation, which may be important in infants with dysfunctional cerebral autoregulation.
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Ann. Thorac. Surg. 2005 80: 28.
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