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Neurologic sequelae associated with deep hypothermic circulatory arrest

P R Hickey1

  • 1Department of Anesthesia, Children's Hospital, Boston, Massachusetts 02115, USA.

The Annals of Thoracic Surgery
|July 1, 1998
PubMed
Summary
This summary is machine-generated.

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Deep hypothermic circulatory arrest in infants undergoing heart surgery can lead to neurologic issues. Low-flow bypass and pH-stat strategies offer better neurologic outcomes compared to circulatory arrest and alpha-stat methods, respectively.

Area of Science:

  • Pediatric Cardiology
  • Neurology
  • Cardiovascular Surgery

Background:

  • Conflicting results exist regarding neurologic disturbances after deep hypothermic circulatory arrest (DHCA).
  • This study reviews the Boston Circulatory Arrest Study and a comparative study of alpha-stat and pH-stat strategies in infants undergoing DHCA.

Purpose of the Study:

  • To compare neurologic outcomes in infants undergoing deep hypothermic circulatory arrest.
  • To evaluate the impact of alpha-stat versus pH-stat strategies on neurologic outcomes.

Main Methods:

  • The Boston Circulatory Arrest Study involved 171 infants (<3 months), with neurologic evaluations at perioperative, 1, and 4 years.
  • A second study included 182 infants (≤9 months) to compare alpha-stat and pH-stat strategies, assessing EEG seizures, recovery time, and mortality/morbidity.

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Main Results:

  • Longer circulatory arrest duration correlated with increased seizures and delayed EEG recovery.
  • One-year follow-up showed duration of arrest linked to lower psychomotor index and more neurologic abnormalities.
  • Four-year follow-up indicated no difference in general IQ between low-flow and circulatory arrest, but arrest duration affected cognitive subscores.
  • The alpha-stat strategy was associated with more EEG seizures, higher morbidity/mortality, and longer EEG recovery time compared to pH-stat.

Conclusions:

  • Low-flow bypass is associated with better neurologic outcomes than circulatory arrest in infants with complex congenital heart defects.
  • The pH-stat strategy demonstrates a better neurologic outcome compared to the alpha-stat strategy when circulatory arrest is employed.