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Deep hypothermic circulatory arrest: II. Changes in electroencephalogram and evoked potentials during rewarming
M M Stecker1, A T Cheung, A Pochettino
1Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA. mark_stecker@yahoo.com
The Annals of Thoracic Surgery
|February 24, 2001
Summary
Neurophysiologic monitoring during rewarming after hypothermic circulatory arrest reveals that evoked potentials recover before electroencephalogram (EEG) activity. Higher rewarming temperatures correlate with increased risk of neurologic impairment.
Area of Science:
- Neuroscience
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Electrophysiologic studies during rewarming are crucial for understanding brain status after deep hypothermic circulatory arrest.
- These studies offer insights into neurological effects and outcomes following circulatory arrest.
Purpose of the Study:
- To investigate the neurophysiologic events during rewarming after hypothermic circulatory arrest.
- To correlate electrophysiologic recovery patterns with postoperative neurologic outcomes.
Main Methods:
- Electroencephalogram (EEG) and evoked potentials were monitored in 109 patients during rewarming after aortic surgery with hypothermic circulatory arrest.
- Correlation analyses were performed between neurophysiologic recovery times, temperatures, and neurologic impairment.
Main Results:
- The sequence of neurophysiologic recovery during rewarming (evoked potentials, then EEG burst-suppression, then continuous EEG) differed from cooling.
- Time to recovery of evoked potentials N20-P22 complex correlated with circulatory arrest duration.
- Higher nasopharyngeal temperatures at EEG continuity and evoked potential return were strongly correlated with postoperative neurologic impairment.
Conclusions:
- Rewarming temperature at which continuous EEG activity and evoked potentials return is a significant predictor of postoperative neurologic impairment.
- Cerebral protection appears uniform regardless of hypothermic circulatory arrest temperature, suggesting cooling to electrocerebral silence is key.
