Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study

Axel Fudickar, Sönke Peters, Claudia Stapelfeldt, Götz Serocki, Jörn Leiendecker, Patrick Meybohm, Markus Steinfath, Berthold Bein, Axel Fudickar, Sönke Peters, Claudia Stapelfeldt, Götz Serocki, Jörn Leiendecker, Patrick Meybohm, Markus Steinfath, Berthold Bein

Abstract

Background: Neurologic deficits after cardiac surgery are common complications. Aim of this prospective observational pilot study was to investigate the incidence of postoperative cognitive deficit (POCD) after cardiac surgery, provided that relevant decrease of cerebral oxygen saturation (cSO2) is avoided during cardiopulmonary bypass.

Methods: cSO2 was measured by near infrared spectroscopy in 35 patients during cardiopulmonary bypass. cSO2 was kept above 80% of baseline and above 55% during anesthesia including cardiopulmonary bypass. POCD was tested by trail making test, digit symbol substitution test, Ray's auditorial verbal learning test, digit span test and verbal fluency test the day before and 5 days after surgery. POCD was defined as a decline in test performance that exceeded - 20% from baseline in two tests or more. Correlation of POCD with lowest cSO2 and cSO2 - threshold were determined explorative.

Results: POCD was observed in 43% of patients. Lowest cSO2 during cardiopulmonary bypass was significantly correlated with POCD (p = 0.015, r2 = 0.44, without Bonferroni correction). A threshold of 65% for cSO2 was able to predict POCD with a sensitivity of 86.7% and a specificity of 65.0% (p = 0.03, without Bonferroni correction).

Conclusions: Despite a relevant decrease of cerebral oxygen saturation was avoided in our pilot study during cardiopulmonary bypass, incidence of POCD was comparable to that reported in patients without monitoring. A higher threshold for cSO2 may be needed to reduce the incidence of POCD.

Figures

Figure 1
Figure 1
Cerebral oxygen saturation (cSO2) at points of interest before induction of anaesthesia (Baseline), during anaesthesia before cardiopulmonary bypass (Anaesthesia), during cardiopulmonary bypass (CPB, 0 min - 150 min) and during anaesthesia after cardiopulmonary bypass (post CPB). The additional grid line shows the absolute lower limit of cSO2 (55%). Data is given as median, 25th/75th percentile and range.
Figure 2
Figure 2
Correlation of severity of postoperative neurocognitive deficit (POCD) defined as the number of tests with clinically relevant decline (decrease of postoperative test results below 80% of preoperative baseline) after cardiac surgery with minimal cSO2 during cardiopulmonary bypass by trend (p = 0.015, r2 = 0.44, without Bonferroni correction). POCD was investigated by a set of five neuropsychological tests 1 day before and 4 days after heart surgery with cardiopulmonary bypass.
Figure 3
Figure 3
Receiver-operator characteristic (ROC) curve of an absolute threshold of 65% for minimal cSO2 during cardiopulmonary bypass. The threshold discriminates patients with and without postoperative neurocognitive deficit with a sensitivity of 86.7% and a specificity of 65.0% by trend (p = 0.03, AUC = 0.61, without Bonferroni correction). Dashed line is line of identity.

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Source: PubMed

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