Baseline hemodynamic state and response to hemodilution in patients with acute cerebral ischemia

James C. Grotta, L. Creed Pettigrew, Steven Allen, Alan Tonnesen, Frank M. Yatsu, Jean Gray, John Spydell

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Hemodynamic data were obtained in 9 patients (mean age 65 yrs) with carotid territory cerebral infarct within the preceding 24 hours (mean 14 ± 8) as part of a pilot study testing the feasibility and safety of hyper volemic hemodilution. Pulmonary arterial catheters (PACs) were placed without complication in all patients, and after baseline measurements were obtained, up to 1500 cc of 6% hetastarch in 0.9% sodium chloride was administered the first day and up to 1000 cc per day the second and third days. Pulmonary wedge pressure (PWP) rose from 6.3 ± 3.5 to 14.4 ± 3.4 mm Hg (p < 0.001) without development of congestive heart failure in any patient. This was accompanied by a drop in hematocrit (Hct) from 40.3 ± 3.4 to 32.9 ± 2.0 (p< 0.001) and rise in cardiac output (CO) from 4.3 ± 1.0 to 5.3 ± 0.6 (p < 0.05). Phlebotomy of 250 cc was performed in 2 patients and 500 cc in one in order to reduce Hct to desired levels. The volume of fluid needed to raise PWP to 15 was unpredictable (2361 ± 1106 cc) and therefore PACs were necessary to monitor the rate and volume of fluid administration. The data show that PWP is sufficiently low and Hct sufficiently high following stroke in most patients that hemodilution by volume expansion with phlebotomy added if necessary can be undertaken safely with appropriate monitoring of hemodynamic function, and that this therapy results in optimal reduction of Hct and increased CO without risk of hypotension.

Original languageEnglish
Pages (from-to)790-795
Number of pages6
Issue number5
StatePublished - 1985

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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