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Articles in PresS, published online ahead of print November 8, 2001
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00880.2001
Submitted on October 10, 2001
Accepted on November 2, 2001
1 Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
2 Biological Chemistry, University of Maryland School of Medicine, Baltimore, Maryland, USA
* To whom correspondence should be addressed. E-mail: rkoehler{at}jhmi.edu.
The beneficial effect of hemodilution on cerebral blood flow (CBF) during focal cerebral ischemia is mitigated by reduced arterial oxygen content (CaO2). In anesthetized cats subjected to permanent middle cerebral artery occlusion, the time course of regional CBF was evaluated after isovolemic exchange transfusion with either albumin or a tetrameric hemoglobin-based oxygen carrier. The transfusion started 30 minutes after arterial occlusion. We tested the hypothesis that bulk oxygen transport (CBF X CaO2) to ischemic tissue is increased by hemoglobin transfusion at a hematocrit of 18% compared to albumin-transfused cats at a hematocrit of 18% or control cats at a hematocrit of 30% and equivalent arterial pressure. In the non-ischemic hemisphere, CBF increased selectively after albumin transfusion, and oxygen transport was similar among groups. In ischemic cortex, albumin transfusion increased CBF, but oxygen transport was not increased above that of the control group. Hemoglobin transfusion increased both CBF and oxygen transport in ischemic cortex above values in the control group, but the increase was delayed until 4 hours of ischemia. Consequently, acute injury volume measured at 6 hours of ischemia was not significantly attenuated. In contrast to cortex, CBF in ischemic caudate nucleus was not substantially increased by either albumin or hemoglobin transfusion. Therefore, in a large animal model of permanent focal ischemia in which transfusion starts 30 minutes after ischemia, tetrameric cross-linked hemoglobin transfusion can augment oxygen transport to ischemic cortex, but the increase can be delayed and not necessarily provide protection. Moreover, an end-artery region such as caudate nucleus is less likely to benefit from hemodilution.
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