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Neuropsychologic outcome after deep hypothermic circulatory arrest in adults
D L Reich1, S Uysal, M Sliwinski
1Departments of Anesthesiology, Cardiothoracic Surgery, and Rehabilitation Medicine, The Mount Sinai-New York University Medical Center, New York, NY 10029-6574, USA.
Insights
Deep hypothermic circulatory arrest exceeding 25 minutes in adults undergoing thoracic aortic repair is linked to long-term memory and fine motor deficits. This duration also predicts longer hospital stays, highlighting risks associated with prolonged deep hypothermic circulatory arrest.
Area of Science:
- Cardiovascular Surgery
- Neuropsychology
- Critical Care Medicine
Background:
- Pediatric studies indicate cognitive deficits after deep hypothermic circulatory arrest (DHCA).
- Limited data exists on long-term cognitive outcomes in adult patients undergoing DHCA for thoracic aortic repairs.
Purpose of the Study:
- To investigate the association between DHCA duration and long-term neuropsychological outcomes in adult patients undergoing thoracic aortic repair.
Main Methods:
- 149 patients evaluated preoperatively and postoperatively using a battery of 8 neuropsychological tests.
- Patients were categorized by DHCA duration: none (n=73), 1-24 minutes (n=36), and ≥25 minutes (n=40).
- Neuropsychological changes from baseline were analyzed using ANCOVA, logistic regression, and survival functions.
Main Results:
- Poor early postoperative performance predicted late deficits across all cognitive domains.
- DHCA ≥25 minutes and advanced age predicted late memory and fine motor deficits.
- DHCA ≥25 minutes was a significant determinant of prolonged hospital stay (>21 days).
Conclusions:
- Longer durations of DHCA (≥25 minutes) are associated with significant memory and fine motor deficits in adults.
- Advanced age is also a predictor of these cognitive deficits.
- Extended DHCA duration is linked to increased hospital length of stay.
Introduction:
Pediatric patients undergoing prolonged periods of deep hypothermic circulatory arrest have been found to experience long-term deficits in cognitive function. However, there is limited information of this type in adult patients who are undergoing deep hypothermic circulatory arrest for thoracic aortic repairs.
Methods:
One hundred forty-nine patients undergoing elective cardiac or thoracic aortic operations were evaluated preoperatively; 106 patients were evaluated early in the postoperative period (EARLY), and 77 patients were evaluated late in the postoperative period (LATE) with a battery of neuropsychologic tests. Seventy-three patients had routine cardiac operations without deep hypothermic circulatory arrest, and 76 patients with deep hypothermic circulatory arrest were divided into 2 subgroups: those with 1 to 24 minutes of deep hypothermic circulatory arrest (n = 36 patients) and those with 25 minutes or more of deep hypothermic circulatory arrest (n = 40 patients). The neuropsychologic test battery consisted of 8 tests encompassing 5 domains: attention, processing speed, memory, executive function, and fine motor function. Data were normalized to baseline values, and changes from baseline were analyzed by analysis of covariance, multivariate logistic regression, and survival functions.
Results:
In all domains, poor performance or inability to be tested EARLY were significant predictors of poor performance LATE (odds ratio, 5.27; P <.01). Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were significant predictors of poor performance LATE for the memory and fine motor domains. Deep hypothermic circulatory arrest of 25 minutes or more (odds ratio, 4. 0; P =.02) was a determinant of prolonged hospital stay (>21 days).
Conclusion:
Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were associated with memory and fine motor deficits and with prolonged hospital stay.