Systemic steroid pretreatment improves cerebral protection after circulatory arrest

• Published in: The Annals of thoracic surgery Vol. 72; no. 5; pp. 1465 - 1472
• Main Authors: Shum-Tim, Dominique, Tchervenkov, Christo I, Jamal, Al-Maleek, Nimeh, Toni, Luo, Chwan-Yau, Chedrawy, Edgar, Laliberte, Eric, Philip, Anie, Rose, Colin P, Lavoie, Josee
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2001
• Subjects: Animals; Brain Injuries - etiology; Brain Injuries - metabolism; Brain Injuries - pathology; Brain Injuries - prevention & control; Cardiopulmonary Bypass - adverse effects; Electric Impedance; Glucocorticoids - therapeutic use; Heart Arrest, Induced - adverse effects; Methylprednisolone Hemisuccinate - therapeutic use; Neuroprotective Agents - therapeutic use; Preoperative Care; Swine; 19
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(01)03129-0

Background. This study evaluates whether systemic steroid pretreatment enhances neuroprotection during deep hypothermic circulatory arrest (DHCA) compared with steroid in cardiopulmonary bypass (CPB) prime. Methods. Four-week-old piglets randomly placed into two groups (n = 5 per group) were given methylprednisolone (30 mg/kg) into the pump prime (group PP), or pretreated intravenously 4 hours before CPB (group PT). All animals underwent 100 minutes of DHCA (15°C), were weaned off CPB, and were sacrificed 6 hours later. Postoperative changes in body weight, bioimpedance, and colloid oncotic pressure (COP) were measured. Cerebral trypan blue content, immunohistochemical evaluation of transforming growth factor-β 1 (TGF-β 1) expression, and caspase-3 activity were performed. Results. Percentage weight gain (group PP 25.0% ± 10.4% versus group PT 12.5% ± 4.0%; p = 0.036), and percentage decrease in bioimpedance (PP 37.2% ± 14.5% versus PT 15.6% ± 7.9%; p = 0.019) were significantly lower, whereas postoperative COP was significantly higher in group PT versus group PP (PT 15.3 ± 1.8 mm Hg versus PP 11.6 ± 0.8 mm Hg; p = 0.003). Cerebral trypan blue (ng/g dry tissue) was significantly lower in group PT (PT 5.6 × 10 -3 ± 1.1 × 10 -3 versus PP 9.1 × 10 -3 ± 5.7 × 10 -4; p = 0.001). Increased TGF-β 1 expression and decreased caspase-3 activity were shown in group PT. Conclusions. Systemic steroid pretreatment significantly reduced total body edema and cerebral vascular leak and was associated with better immunohistochemical indices of neuroprotection after DHCA.