Assessment of postoperative risk factors for EEG abnormalities in routine clinical management after paediatric cardiopulmonary bypass

Abstract

OBJECTIVES The postoperative risk factors for electroencephalogram(EEG) abnormalities after paediatric cardiopulmonary bypass (CPB) remain to be identified. We investigated the characteristics of EEG abnormalities and risk factors in routine clinical management post-CPB. METHODS EEG and cerebral oxygen saturation (ScO2) were monitored in 96 patients (aged 3 days, 37 months, median 5 months) for 72 h post-CPB. Clinical measurements included 4-hourly arterial and central venous pressure, arterial blood gases, doses of inotropic and vasoactive drugs, daily C-reactive protein (CRP) and NT-proB-type Natriuretic Peptide (NT-proBNP). Demographics, STAT categories and outcomes (duration of mechanical ventilation, CICU stay) were recorded. Un RESULTS Seizures occurred in 20 patients (20.8%) beginning at 0–48 hand lasting 10 min–31 h; background abnormalities occurred in 67 (69.8%) beginning at 0–8 h and lasting 4–48 h. Patients with EEG abnormalities had worse outcomes. In univariable regression, seizures positively correlated with STAT categories, CPB time, temperature, blood pressure, central venous pressure, NT-proBNP, CRP, lactate and epinephrine, negatively with ScO2 and PaCO2 (P < 0.001 for lactate and epinephrine, P < 0.1 for the remaining). The degree of background abnormalities positively correlated with STAT categories, CPB time, operative time, central venous pressure, milrinone, negatively with blood pressure (P = 0.0003–0.087); it negatively correlated with lower dose of epinephrine (P < 0.001) and positively with higher dose (P = 0.03l). In multivariable regression, seizures positively correlated with epinephrine, lactate and temperature; the background abnormality correlations remain significant except for milrinone and operative time (P < 0.001 for epinephrine, P < 0.05 for the remaining). CONCLUSIONS Numerous perioperative risk factors are associated with EEG abnormalities post-CPB. The most significant and consistent risk factor is epinephrine.

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

“…A significant increase in length of intensive care unit (ICU) stay was observed in the group of EEG seizures after CPB as compared with the no EEG seizures group both in adults (WMD = 5.2 days; 95% CI: 1.908–8.475; P = 0.002) ( 17 , 23 , 24 ) and pediatrics (WMD = 7.1 days; 95% CI: 3.239–10.965; p < 0.001) ( 20 , 21 ).…”

“…As for ventilator support, a trend of increase in the EEG seizures group in adults was observed as compared with the no EEG seizures group (WMD = 3.4 days; 95% CI: -0.305 to 7.157, p = 0.072) (17,24). However, no significant increase was detected in the EEG seizures group of pediatrics after CPB (WMD = 3.2 days; 95%CI: -2.536 to 8.874; p = 0.276) (19)(20)(21).…”

“…Meanwhile, no statistical significance was detected in the EEG seizures group after ECMO (WMD: 3.301 days; 95%CI: -20.072 to 26.673; p = 0.782) (6,18) in pediatric. However, a dramatic increase was observed in the group of EEG seizures after CPB as compared with the no EEG seizures group (WMD = 8.8 days; 95%CI: 1.3-16.385; P = 0.022) in pediatric (19)(20)(21)(22).…”

The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery

“…Note that all patients received postoperative monitoring, while 108 (49.3%) received both perioperative and postoperative monitoring because the former was extended later after our initial ndings concerning intraoperative events. 10 Obvious data artifacts were manually deleted.…”

“…Background abnormalities were classi ed as normal, mild, moderate, and severe following previous methods. 10 All EEGs were analyzed by the quali ed technicians (R Lin and S Ning) independently.…”