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A Systematic Review of How Cardiopulmonary Bypass Parameters Influence Electroencephalogram Signals
Han Bao1, Jiaying Wang1, Ziru Cui1
1Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China.
Brain Sciences
|April 27, 2026
Summary
Cardiopulmonary bypass (CPB) affects brain function during cardiac surgery, altering electroencephalography (EEG) signals. Specific EEG patterns predict neurological complications like stroke and delirium, highlighting the need for multimodal brain monitoring.
Area of Science:
- Neuroscience
- Cardiology
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) is crucial for cardiac surgery but elevates the risk of perioperative neurological complications.
- Electroencephalography (EEG) offers real-time brain function monitoring and early cerebral injury detection.
- A comprehensive understanding of CPB's impact on EEG and its clinical integration is lacking.
Purpose of the Study:
- To systematically review how CPB-related factors (temperature, MAP, hemodilution, anesthetics, embolization, inflammation) influence EEG parameters.
- To evaluate the association between EEG changes and postoperative delirium (POD) and stroke.
- To synthesize insights for improved clinical decision-making in brain protection during CPB.
Main Methods:
- Systematic literature search following PRISMA 2020 guidelines in PubMed, Web of Science, and related databases (1974-2025).
- Inclusion of original English-language articles on adult patients undergoing cardiac surgery with CPB and intraoperative EEG monitoring.
- Exclusion of reviews, case reports, animal studies, pediatric cases, and inaccessible full texts; narrative synthesis of extracted data.
Main Results:
- Hypothermia linearly decreases Bispectral Index (BIS); deep hypothermia causes electrocerebral silence; EEG recovery predicts POD.
- MAP decline rate is a stronger EEG abnormality predictor than absolute value; hemodilution below hemoglobin 9.2 g/dL increases EEG slowing risk.
- EEG epileptiform discharges increase POD risk five-fold; decreased LIR predicts stroke and POD; persistent EEG changes elevate POD risk.
Conclusions:
- Distinct CPB-related factors influence EEG via specific mechanisms, with patterns like slowing and burst suppression linked to neurological complications.
- Multimodal monitoring (EEG, cerebral oximetry, hemodynamics) with defined thresholds aids individualized brain protection.
- Future interventional studies using real-time EEG feedback are necessary to confirm improved long-term neurological outcomes.
