Cerebral Outcome After Extracorporeal Circulation

Sotaniemi, K. A.

doi:10.1001/archneur.1983.04050020037006

Cited by 84 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When considering all degrees of impairment, rates are reported to range from 25–79%, with stroke comprising up to 6.1%[1, 7, 8, 10, 11] of these patients, commensurate with our findings. Although often transient, the immediate and long-term sequelae of these post-operative NDs are shown by their associated mortality, LOS and final disposition.…”

Section: Commentsupporting

confidence: 89%

“…Though many studies have shown multiple predisposing risk factors for ND including age, cerebrovascular disease history, diabetes, hypertension and the requirement of an IABP[5, 7, 8, 11–14, 16], none of these proved to be predictive for a positive early non-contrast head CT. Only focality and aortic procedures were associated with a positive finding on non-contrast CT.…”

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Head Computed Tomography Imaging in the Evaluation of Postoperative Neurologic Deficits in Cardiac Surgery Patients

Beaty

Arnaoutakis

Grega

et al. 2013

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Background Computed tomography(CT) scans of the head without contrast are routinely obtained to evaluate neurologic deficits after cardiac surgery(CS), but their utility is unknown. We evaluated our experience with this imaging modality to determine its value. Methods We retrospectively identified CS patients with postoperative neurologic deficits occurring during the first week after surgery between January 2000 and December 2012. Stroke was defined by neurologist’s determination, while a non-focal deficit(NFD) was defined by the presence of seizure, delirium, or cognitive impairment. We defined early non-contrast head CT as occurring within 7 days of surgery. Outcomes included positive findings on CT, in-hospital mortality and length of stay(LOS). Multivariate logistic regression identified predictors of positive findings on head CT. Results Within the population of 11,070 postoperative patients, 451 had early non-contrast head CT scans (4%). 202(44.7%) were associated with stroke and 249(55.2%) with NFD. Among stroke patients, 40/202(20%) showed acute infarction, 17/202(8%) showed sub-acute infarction, and 5/202(2%) showed hemorrhage. Among NFD patients, 1/248(0.4%) showed acute infarction, 4/248(1.6%) sub-acute infarction, and 1/248(0.4%) hemorrhage. There was no difference in in-hospital mortality(S:42/201(21%) versus NFD:41/248(16%), p=0.2) or LOS (S:24d versus NFD:22d, p=0.5). On multivariable logistic regression, only focal deficits and aortic procedures predicted a positive finding on CT scan. Conclusions To our knowledge, this is the only modern study to review the utility of early postoperative non-contrast head CT in CS patients. With focal neurologic deficits, this imaging modality was positive for approximately one third of patients, but rarely positive for NFD. Its use in this setting has limited utility.

show abstract

Section: Commentsupporting

confidence: 89%

Section: Commentmentioning

confidence: 99%

The Role of Head Computed Tomography Imaging in the Evaluation of Postoperative Neurologic Deficits in Cardiac Surgery Patients

Beaty

Arnaoutakis

Grega

et al. 2013

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Although overall mortality associated with CPB has declined, the portion of deaths resulting from neurological injury has increased (3). The problem will likely increase parallel to the demo-graphic shift toward more elderly patients (25), because increasing age is well known to increase risk for postoperative cognitive decline and stroke (19,21,(26)(27)(28)(29)(30)(31). In addition to microembolic events, cerebral hypoperfusion has been demonstrated to be involved in cognitive dysfunction and stroke (4).…”

Section: Discussionmentioning

confidence: 99%

The Effect of PaCO₂ on Cerebral Perfusion: An Experimental Swine Model

Trowbridge,

Stammers,

Niimi

et al. 2001

J Extra Corpor Technol

View full text Add to dashboard Cite

Adequate cerebral perfusion is of particular concern to the clinician and is a major factor in postoperative morbidity. Cerebral circulation has the ability to autoregulate blood flow in order to maintain nutrient delivery and prevent high intravascular pressures. The focus of this study was to characterize the impact of gradually changing arterial CO2 levels on cerebral perfusion. A total of eight porcine subjects were placed into either a normothermic group (NG, N = 4, rectal temperature = 35.4 ± 1.2° C) or a hypothermic group (HG, N = 4, 30.6 ± 0.6° C). After initiation of cardiopulmonary bypass, the PaCO2 values sequentially varied between 24 and 56 mmHg. Arterial, venous, and internal jugular blood gas data were collected at 4 mmHg increments, and relative cerebral blood flow was calculated as CBF = 1 (CarterialO2–CjugularO2)−1 Physiological parameters were similar in both groups across all test conditions: mean arterial pressure— NG 81.6 ± 11.9 mmHg versus HG 73.4 ± 7.0 mmHg, p = NS, and systemic oxygen consumption—HG 110.6 ± 30.0 mL min−1 versus NG 136.4 ± 37.9 mL min−1, p = NS. No significant differences were found in CBF in the NG (21.8 ± 4.4 mL min−1 100 gL at PaCO2= 56 mmHg versus 20.5 ± 5.0 mL min−1 100 g−1 at PaCO2 = 24 mmHg) or the HG (24.3 ± 9.5 mL min−1 100 g−1 at PaCO2 = 56 mmHg versus 25.6 ± 12.0 mL min−1 100 g−1 at PaCO2 = 24 mmHg). In conclusion, the alteration of PaCO2 under both hypothermic and normothermic conditions resulted in no significant differences in 1 (CarterialO2 – CjugularO2)−1 in this model.

show abstract