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Published on: October 27, 2020
Effect of the Duration of Deep Hypothermic Circulatory Arrest on the Neurodevelopmental Outcomes in Children
Abdullah H Ghunaim1,2, Basma Aljabri3, Ahmed Dohain4,5
1Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Insights
Deep hypothermic circulatory arrest (DHCA) in young children may be linked to subtle neurodevelopmental deficits. Longer DHCA duration showed a trend towards lower motor scores, suggesting potential long-term impacts.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Cardiothoracic Surgery
Background:
- Deep hypothermic circulatory arrest (DHCA) is a critical procedure in pediatric cardiac surgery.
- While generally safe, concerns exist regarding potential long-term neurodevelopmental deficits following DHCA.
Purpose of the Study:
- To investigate the association between the duration of DHCA and neurodevelopmental outcomes in young children.
- To identify specific neurodevelopmental domains affected by DHCA in this pediatric population.
Main Methods:
- A cohort study comparing children under 42 months undergoing cardiac surgery with DHCA versus those without.
- Neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development (BSTID) was performed.
- Statistical analysis, including multivariable regression, was used to adjust for confounding factors.
Main Results:
- No significant preoperative, operative, or postoperative differences were found between groups.
- Prematurity and age at assessment were significant predictors of BSTID components.
- Longer DHCA duration showed a non-statistically significant trend towards lower fine and gross motor scores (p=0.06).
Conclusions:
- Long-duration DHCA without regional perfusion may be associated with suboptimal neurodevelopmental outcomes in young children.
- Further research with larger sample sizes is warranted to confirm these findings and explore mitigation strategies.
Abstract:
Background/Objectives: Deep hypothermic circulatory arrest (DHCA) is safe, but subtle neurodevelopmental deficits may persist far beyond the perioperative period. We aimed to investigate the relationship between DHCA duration and neurodevelopmental outcomes in young children undergoing cardiac surgery with DHCA. Methods: Children aged < 42 months, including neonates who underwent cardiac surgery using DHCA without regional perfusion techniques, were included as the DHCA group. Children in the same age range who underwent cardiac surgery without DHCA were included as the control group. All enrolled patients underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development (BSTID) by a trained pediatrician, and 17 DHCA patients and 6 control patients completed the BSTID assessment. Results: Both groups showed no significant preoperative, operative, or postoperative differences. Adjusted multivariable analysis revealed that prematurity and age at assessment were significant changing predictors of each of the BSTID components (p < 0.001), except for the gross motor component, where only age at assessment was a significant adjusting predictor. Longer DHCA was associated with lower fine and gross motor BSTID components; however, the association was not statistically significant (p = 0.06). Conclusions: Long-duration DHCA without regional perfusion techniques may be associated with less optimal neurodevelopmental outcomes.
