Diop Sylvain, Nader Marwan, Fadel Elie, Kassab Maria Cristina, Ghadbane Hamdi, Ion Iolanda, Thes Jacques
Department of Anesthesiology, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France - Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France.
Department of Anesthesiology, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France.
J Extra Corpor Technol. 2025 Sep;57(3):123-128. doi: 10.1051/ject/2025014. Epub 2025 Sep 15.
During deep hypothermic circulatory arrest (DHCA) for pulmonary artery endarterectomy (PAE), the blood volume stored in the cardiotomy reservoir circulates through the oxygenator via the arterial shunt line, where it remains oxygenated and decarboxylated. The aim of the study was to investigate the change in the acid-base balance of the blood contained in the cardiotomy reservoir during DHCA.
A four-month retrospective analysis was conducted on patients undergoing PAE. The sweep gas inflow and the inspired fraction of O were kept constant throughout the duration of DHCA. Arterial blood gases were sampled at the beginning and at the end of the DHCA and were analyzed according to the alpha-stat and pH-stat strategies.
Twenty-four patients were included with a mean age of 59.2 (±15.7) years. The mean duration of DHCA was 15.2 (±4.1) min and the mean sweep gas inflow was 1.4 (±0.8) L/min. Initial pH and PaCO were 7.31 (±0.09) and 43.2 (±9.9) mmHg, respectively, and final pH and PaCO were 7.51 (± 0.14), p < 0.001 and 23.4 (±11.9) mmHg, p < 0.001. There was a significant correlation between the sweep gas inflow and the post-DHCA pH (r = 0.797).
The pH increases significantly during the DHCA according to the sweep gas inflow. Decreasing the sweep gas inflow between 0.5 and 1.0 L/min allows for limiting the pH variation during the DHCA period.
在肺动脉内膜剥脱术（PAE）的深低温停循环（DHCA）期间，心内直视手术储血器中储存的血容量通过动脉分流管在氧合器中循环，在那里血液保持氧合和脱羧状态。本研究的目的是调查DHCA期间心内直视手术储血器中血液酸碱平衡的变化。
对接受PAE的患者进行了为期四个月的回顾性分析。在整个DHCA期间，吹扫气体流入量和氧气吸入分数保持恒定。在DHCA开始时和结束时采集动脉血气样本，并根据α-stat和pH-stat策略进行分析。
纳入24例患者，平均年龄59.2（±15.7）岁。DHCA的平均持续时间为15.2（±4.1）分钟，平均吹扫气体流入量为1.4（±0.8）升/分钟。初始pH值和动脉血二氧化碳分压分别为7.31（±0.09）和43.2（±9.9）mmHg，最终pH值和动脉血二氧化碳分压分别为7.51（±0.14），p<0.001和23.4（±11.9）mmHg，p<0.001。吹扫气体流入量与DHCA后pH值之间存在显著相关性（r=0.797）。
根据吹扫气体流入量，DHCA期间pH值显著升高。将吹扫气体流入量降低至0.5至1.0升/分钟之间可限制DHCA期间的pH值变化。
