Effect of the No-Flow Interval and Hypothermia on Cerebral Blood Flow and Metabolism During Cardiopulmonary Resuscitation in Dogs

Abstract

Background and Purpose —We sought (1) to determine the effect of brief periods of no flow on the subsequent forebrain blood flow during cardiopulmonary resuscitation (CPR) and (2) to test the hypothesis that hypothermia prevents the impact of the no-flow duration on cerebral blood flow (CBF) during CPR. Methods —No-flow intervals of 1.5, 3, and 6 minutes before CPR at brain temperatures of 28°C and 38°C were compared in 6 groups of anesthetized dogs. Microsphere-determined CBF and metabolism were measured before and during vest CPR adjusted to maintain cerebral perfusion pressure at 25 mm Hg. Results —Increasing the no-flow interval from 1.5 to 6 minutes at 38°C decreased the CBF (18.6±3.6 to 6.1±1.7 mL/100 g per minute) and the cerebral metabolic rate (2.1±0.3 to 0.7±0.2 mL/100 g per minute) during CPR. Cooling to 28°C before and during the arrest eliminated the detrimental effects of increasing the no-flow interval on CBF (16.8±1.0 to 14.8±1.9 mL/100 g per minute) and cerebral metabolic rate (1.1±0.1 to 1.3±0.1 mL/100 g per minute). Unlike the forebrain, 6 minutes of preceding cardiac arrest did not affect brain stem blood flow during CPR. Conclusions —Increasing the no-flow interval to 6 minutes in normothermic animals decreases the supratentorial blood flow and cerebral metabolic rate during CPR at a cerebral perfusion pressure of 25 mm Hg. Cooling to 28°C eliminates the detrimental impact of the 6-minute no-flow interval on the reflow produced during CPR. The brain-protective effects of hypothermia include improving reflow during CPR after cardiac arrest. The effect of hypothermia and the impact of short durations of no flow on reperfusion indicate that increasing viscosity and reflex vasoconstriction are unlikely causes of the “no-reflow” phenomenon.