Randomized controlled trial of pericardial blood processing with a cell-saving device on neurologic markers in elderly patients undergoing coronary artery bypass graft surgery
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Published on: September 15, 2023
Michel Carrier1, André Denault, Joel Lavoie
1Department of Surgery, Biomedical Laboratory, Montreal Heart Institute, Montreal, Quebec, Canada. michel.carrier@icm-mhi.org
Insights
Cell-saving devices reduce markers of brain injury in elderly patients undergoing cardiopulmonary bypass. While not improving brain oxygen saturation or neurological scores, this method lowers protein S100B levels post-surgery.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Biomedical Engineering
Background:
- Cardiopulmonary bypass can lead to brain injury, evidenced by lipid microembolization and neurocognitive dysfunction.
- Cell-saving devices are proposed to mitigate these risks by processing shed blood.
- This study investigates the efficacy of cell-saving devices in protecting elderly patients' brains during cardiac surgery.
Purpose of the Study:
- To test if processing pericardial shed blood with a cell-saving device reduces brain injury markers.
- To evaluate the impact on serum protein S100B levels, brain oxygen saturation, and neurological outcomes in elderly patients.
- To assess the protective effect of cell-saving technology during cardiopulmonary bypass.
Main Methods:
- Forty elderly patients (≥65 years) undergoing coronary artery bypass graft surgery were randomized.
- One group received processed pericardial shed blood via a cell-saving device; the control group received standard care.
- Serum protein S100B, brain oxygen saturation (near-infrared spectroscopy), and neurological status (NIH Stroke Scale) were monitored.
Main Results:
- Serum protein S100B levels were significantly lower 30 minutes post-surgery in the cell-saving device group compared to the control group (p < 0.0001).
- No significant differences were observed in brain oxygen saturation or National Institutes of Health stroke scale scores between the groups.
- One cerebrovascular complication occurred in the control group.
Conclusions:
- Cell-saving device use is associated with a lesser release of non-specific brain injury markers, specifically protein S100B, in elderly patients.
- The device did not demonstrate a significant improvement in brain oxygenation or neurological outcomes.
- Processing pericardial shed blood may offer a protective benefit against biochemical markers of brain injury during cardiopulmonary bypass.
Background:
Processing of pericardial shed blood with a cell-saving device was claimed to prevent lipid microembolization and to protect from neurocognitive dysfunction after cardiopulmonary bypass. The present study tested the hypothesis that processing of pericardial shed blood with a cell-saving device during cardiopulmonary bypass would significantly decrease serum levels of protein S100B, and improve brain oxygen saturation and neurologic outcome, all markers of brain injury in elderly patients.
Methods:
Forty patients, 65 years of age and older, undergoing coronary artery bypass graft with cardiopulmonary bypass, were prospectively randomly assigned to processing of pericardial shed blood with a cell-saving device or to conventional use of a standard closed venous reservoir where cardiotomy blood was collected and reinfused through the arterial circuit (control group). Serum in S100B was measured 30 minutes, 4 hours, 24 hours, and 48 hours after surgery. Near-infrared spectroscopy monitoring was performed during the procedure and the National Institutes of Health stroke scale was measured before surgery and at the time of discharge of the hospital.
Results:
Patients in the cell-saving device group averaged 72 +/- 3 years of age and underwent 3.1 +/- 0.7 coronary artery grafts with a mean of 62 +/- 20 minutes of cardiopulmonary bypass time. Patients in the control group averaged 75 +/- 4 years of age (p = 0.03) and underwent 3.3 +/- 0.6 coronary artery grafts (p = 0.49) with a mean of 75 +/- 25 minutes of cardiopulmonary bypass time (p = 0.12). The quantity of blood administered from the cell-saving device averaged 281 +/- 162 mL per patient. Serum protein S100B levels averaged 0.06 +/- 0.03 before surgery and 0.51 +/- 0.23 microg/L 30 minutes after surgery in the cell-saving device patients compared with 0.076 +/- 0.04 before surgery (p = 0.32) and 1.48 +/- 0.66 (p < 0.0001) in the control patients. The near-infrared spectroscopy baseline mean value of left and right cortical region was 58% +/- 12% and 55% +/- 7% in the cell-saving device group versus 59% +/- 7% and 53% +/- 6% in the control group (p = 0.67 and 0.36), and no difference occurred over time in each group. The National Institutes of Health stroke score before and after surgery was similar in the two groups. There was one cerebrovascular complication in the control group (1 of 20, 5%) after surgery.
Conclusions:
The difference between the two groups occurred 30 minutes after surgery, at which time serum levels of protein S100B were significantly higher in the control group compared with cell-saving device patients. Although use of the cell-saving device was not associated with higher brain oxygen saturation nor changes in the National Institutes of Health stroke score, it is associated with lesser release of nonspecific markers of brain injury in elderly patients.
