Neuromonitoring during hypothermic cardiopulmonary bypass

Area of Science:

• Neurology
• Cardiovascular Surgery
• Neuroscience

Background:

• Neurological and neuropsychological dysfunction are significant risks following hypothermic cardiopulmonary bypass (CPB).
• Current clinical practice infrequently utilizes central nervous system (CNS) monitoring during CPB, despite its potential benefits.
• The impact of CNS monitoring on postoperative outcomes remains under investigation.

Purpose of the Study:

• To highlight the necessity of CNS monitoring before, during, and after CPB to mitigate neurological complications.
• To discuss the characteristics of an optimal CNS monitoring strategy for CPB patients.
• To review currently evaluated CNS monitoring devices and their diagnostic capabilities.

Main Methods:

• Evaluation of various CNS monitoring devices, including computer-processed electroencephalogram (cEEG), jugular bulb saturation (SjO2), Doppler flow measurement, and near-infrared spectroscopy (NIRS).
• Assessment of the diagnostic power of individual monitoring techniques.
• Consideration of patient-specific factors, CPB technique, and duration in relation to monitoring needs.

Main Results:

• No single CNS monitoring device possesses sufficient diagnostic power for comprehensive brain assessment during CPB.
• Each evaluated monitoring device offers specific diagnostic insights into brain function, perfusion, or metabolism.
• A combination of two or more monitoring devices is likely required to meet the criteria for effective brain monitoring.

Conclusions:

• Effective brain monitoring during CPB necessitates a multimodal approach, combining multiple technologies.
• Further research is required to investigate the impact of combined CNS monitoring on patient outcomes.
• The clinical applicability and cost-effectiveness of these advanced monitoring tools need future evaluation.