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The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery
Alina M Grigore1, Hilary P Grocott, Joseph P Mathew
1Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Slower rewarming after cardiac surgery using cardiopulmonary bypass (CPB) improved neurocognitive function six weeks post-operation. This suggests optimizing rewarming rates may prevent cognitive decline.
Area of Science:
- Cardiology
- Neurology
- Surgical Complications
Background:
- Neurocognitive dysfunction is a frequent complication following cardiac surgery.
- Hypothermic cardiopulmonary bypass (CPB) is standard but may impact cognitive function.
- The rate of rewarming during CPB is a potential modifiable factor.
Purpose of the Study:
- To investigate the impact of rewarming rate on neurocognitive outcomes after cardiac surgery.
- To compare conventional versus slow rewarming during hypothermic CPB.
- To identify factors influencing cognitive changes post-coronary artery bypass graft (CABG) surgery.
Main Methods:
- Prospective study of 165 patients undergoing CABG surgery.
- Two groups: conventional rewarming (4-6°C gradient) and slow rewarming (≤2°C gradient).
- Neurocognitive function assessed at baseline and 6 weeks post-surgery.
Main Results:
- No significant difference in stroke rates between groups.
- Multivariable analysis revealed a significant association between slower rewarming and improved cognitive function (P=0.05).
- Patients in the slow rewarm group demonstrated better cognitive performance at 6 weeks.
Conclusions:
- Slower rewarming during CPB is linked to better cognitive performance at 6 weeks post-cardiac surgery.
- Optimizing rewarming rates and potentially lowering peak temperatures during CPB may mitigate neurocognitive decline.
- This finding has implications for surgical protocols to improve patient outcomes.
Unlabelled:
Neurocognitive dysfunction is a common complication after cardiac surgery. We evaluated in this prospective study the effect of rewarming rate on neurocognitive outcome after hypothermic cardiopulmonary bypass (CPB). After IRB approval and informed consent, 165 coronary artery bypass graft surgery patients were studied. Patients received similar surgical and anesthetic management until rewarming from hypothermic (28 degrees -32 degrees C) CPB. Group 1 (control; n = 100) was warmed in a conventional manner (4 degrees -6 degrees C gradient between nasopharyngeal and CPB perfusate temperature) whereas Group 2 (slow rewarm; n = 65) was warmed at a slower rate, maintaining no more than 2 degrees C difference between nasopharyngeal and CPB perfusate temperature. Neurocognitive function was assessed at baseline and 6 wk after coronary artery bypass graft surgery. Univariable analysis revealed no significant differences between the Control and Slow Rewarming groups in the stroke rate. Multivariable linear regression analysis, examining treatment group, diabetes, baseline cognitive function, and cross-clamp time revealed a significant association between change in cognitive function and rate of rewarming (P = 0.05).
Implications:
Slower rewarming during cardiopulmonary bypass (CPB) was associated with better cognitive performance at 6 wk. These results suggest that a slower rewarming rate with lower peak temperatures during CPB may be an important factor in the prevention of neurocognitive decline after hypothermic CPB.