. Author manuscript; available in PMC: 2011 Aug 1.

Published in final edited form as: Prog Pediatr Cardiol. 2010 Aug 1;29(2):113–122. doi: 10.1016/j.ppedcard.2010.06.005

Table 2.

Potential Strategies and Treatments for Neuroprotection in Pediatric Cardiac Surgery

Treatment/Strategy	Preventive or Reactive/Reparative	Status of Clinical Research Trials	Feasibility	References
CPB techniques: DHCA vs. ACP	Preventive	2 published; low ACP flow rates	+++	35–40
NIRS monitoring and treatment of low rSO₂;autoregulation	Preventive	No prospective studies	+++	3, 8–10
Anesthetic regimens: dexmedetomidine vs. GABA/NMDA agents	Preventive	Retrospective data; no prospective studies	+++	41–47
Therapeutic hypothermia	Preventive/reactive	None in cardiac surgery; complete neonatal HIE, ongoing pediatric cardiac arrest	++++	49–53
Remote ischemic preconditioning	Preventive	One controlled study ongoing	++++	57
Erythropoietin	Preventive/reactive/reparative	One phase I/II trial underway	++	58–63
Neurotrophic factors: BDNF	Preventive/reactive/reparative	None	++	66,67
Umbilical cord stem cells	Preventive/reactive/reparative	None	+	69,70

Abbreviations: CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; ACP, antegrade cerebral perfusion; NIRS, near-infrared spectroscopy; rSO₂, regional cerebral oxygen saturation; GABA, γ-aminobutryric acid receptor agonist; NMDA, N-methyl-D-aspartate receptor antagonist; HIE, hypoxic-ischemic encephalopathy; BDNF, brain-derived neurotrophic factor. Feasibility: ++++, very feasible with current practices; +++, feasible with current practices; ++, less feasible; experimental therapy that would alter current practices; +, not feasible; experimental therapy for future study.