Electroencephalographic seizures during cardiopulmonary bypass

Area of Science:

• Neurology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Seizure activity during cardiopulmonary bypass (CPB) is a recognized but not fully understood complication.
• CPB involves complex physiological alterations that can impact cerebral function.

Purpose of the Study:

• To report and analyze cases of electroencephalographic (EEG) or clinical seizure activity during CPB.
• To investigate potential causes of seizures in patients undergoing cardiac operations with CPB.

Main Methods:

• Retrospective review of eleven cardiac surgery cases with seizure activity during CPB.
• Analysis of clinical events, CPB parameters, and potential contributing factors such as cerebral ischemia and perfusate composition.

Main Results:

• Four patients experienced seizures secondary to acute cerebral ischemia, caused by hypotension, pump-generated emboli, or air embolism during CPB.
• Seven patients developed seizures attributed to a synergistic effect between toxic perfusate substances and altered cerebral physiology (pre-existing or CPB-induced).

Conclusions:

• Seizures during CPB have multifactorial causes, including cerebral ischemia and perfusate-related toxicity.
• Understanding these mechanisms is crucial for preventing and managing neurological complications in cardiac surgery patients on CPB.