Malperfusion During Hypothermic Antegrade Cerebral Perfusion: Cerebral Perfusion Index—An Early Indicator Compared to Cerebral Oximetry

HYPOTHERMIC CIRCULATORY arrest combined with selective cerebral perfusion commonly is employed to permit
surgical repair of the ascending and transverse aorta. A variety of perfusion techniques are employed, including retrograde cerebral perfusion via the superior vena cava (SVC), unilateral antegrade cerebral perfusion (ACP) via the innominate or right subclavian arteries, or perfusion with selective cannulation of both carotid arteries.1 The degree of hypothermia also varies markedly, from deep hypothermic levels (14-181C) to more modest levels (26-281C). A variety of neuromonitoring techniques are employed to assess the adequacy of the cerebral perfusion, including electroencephalogram (EEG) (raw and processed), regional cerebral saturation (RSO2), and cerebral blood flow. Each is sensitive to different aspects of malperfusion with different response rates and thresholds for abnormality. The authors present a case of ACP monitored with both cerebral saturation and cerebral flow index, during which
malposition of the ACP cannula occurred. The case is illustrative of the difference between these monitoring modalities.
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