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The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning
W Pugsley1, L Klinger, C Paschalis
1Department of Psychiatry, University College London Medical School, Middlesex Hospital, England.
Background And Purpose:
Microemboli have been implicated in the etiology of neuropsychological deficits after cardiopulmonary bypass. This study examined the incidence of high-intensity transcranial signals (microemboli) and their relation to changes in neuropsychological performance after surgery.
Methods:
Transcranial Doppler ultrasonography was used to measure middle cerebral artery blood flow velocity and detect microemboli. The number of high-intensity transcranial signals was determined and related to a neurological examination and absolute changes in neuropsychological performance as well as the number of patients considered to exhibit a neuropsychological deficit. Data were available on 100 consenting patients undergoing routine cardiopulmonary bypass. Fifty of the patients were randomly assigned to a procedure that included a 40-microns arterial line filter, and 50 had the procedure without any arterial line filter.
Results:
Significantly more patients were found to have neuropsychological deficits in the group without the arterial line filter at both 8 days (P < .05) and 8 weeks (P < .03) after surgery. In addition, more "soft" neurological signs were found in the nonfiltered group 24 hours after surgery (P < .05). More high-intensity transcranial signals were found in the nonfiltered group, and the number of high-intensity transcranial signals was found to be related to the likelihood of a patient having a neuropsychological deficit at 8 weeks.
Conclusions:
These data suggest that neuropsychological deficits after routine cardiopulmonary bypass are related to the number of microemboli delivered during surgery. Furthermore, the numbers of microemboli may be reduced by including a 40-microns filter on the arterial line.
Insights
Microemboli, or tiny blood clots, are linked to cognitive issues after heart surgery. Using an arterial line filter significantly reduced these microemboli and improved patient outcomes.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Medical Devices
Background:
- Microemboli are suspected contributors to post-cardiopulmonary bypass (CPB) cognitive impairment.
- This study investigated the link between microemboli and neuropsychological deficits following CPB.
Purpose of the Study:
- To determine the incidence of microemboli during CPB.
- To assess the relationship between microemboli and neuropsychological performance changes.
- To evaluate the efficacy of an arterial line filter in reducing microemboli.
Main Methods:
- Transcranial Doppler ultrasonography was used to detect microemboli (high-intensity transcranial signals).
- 100 patients undergoing CPB were studied; 50 used a 40-micron arterial line filter, 50 did not.
- Neuropsychological testing and neurological examinations were performed post-surgery.
Main Results:
- The non-filtered group showed significantly higher rates of neuropsychological deficits at 8 days and 8 weeks post-surgery.
- More microemboli were detected in the non-filtered group.
- The number of microemboli correlated with the likelihood of a neuropsychological deficit at 8 weeks.
Conclusions:
- Neuropsychological deficits after CPB are associated with the number of microemboli.
- Employing a 40-micron arterial line filter can reduce microemboli during CPB surgery.