Comparison of hypervolemic hemodilution concepts in acute stroke

Abstract

Patients suffering from acute ischemic stroke have impaired cerebral autoregulation. For this reason, the perfusion of the penumbra depends directly on BP and CO. The CO can be increased by hypervolemic hemodilution and administration of positive inotropic drugs. In the present study, we examined the effect of different therapy protocols on hemodynamics in three patient groups. In patients with no manifest cardiac insufficiency, suffering from non­ acute cerebrovascular diseases (group 1, n=6) we carried out a hypervolemic hemodilution with an initial loading dose. In a second group of patients (group 2, n=6), suffering from an acute stroke and limited cardiac capacity, we combined hypervolemic hemodilution with administration of digitalis. In a third group of patients, suffering from an acute stroke, without manifest cardiac insufficiency, we combined hypervolemic hemodilution with the administration of sympathomimetics (group 3, n=6). Group 1 showed a rapid, 15% increase in CO that lasted approximately 3 hours. Group 2 showed a slow improvement in CO, which became apparent during the course of the therapy. Group 3 showed a rapid and lasting increase in CO of more than 30% which correlated closely with the administered dopamine/dobutamine dose. Hypervolemic hemodilution alone does not result in a rapid and long­ lasting increase of CO, particularly not in patients with myocardial insufficiency. To improve the hemodynamic status of acute stroke patients, the administration of positive inotropic substances is a viable alternative.