Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery

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Stewart , J A , Särkelä , M O K , Salmi , T , Wennervirta , J , Vakkuri , A P , Vainikka , T L S , Suojaranta , R , Mäki , K , Ilkka , V H , Viertiö-Oja , H & Salminen , U-S 2020 , ' Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery ' , Scandinavian Journal of Surgery , vol. 109 , no. 4 , pp. 320-327 . https://doi.org/10.1177/1457496919863942

Title: Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery
Author: Stewart, J. A.; Särkelä, M. O. K.; Salmi, T.; Wennervirta, J.; Vakkuri, A. P.; Vainikka, T. L. S.; Suojaranta, R.; Mäki, K.; Ilkka, V. H.; Viertiö-Oja, H.; Salminen, U-S
Contributor: University of Helsinki, Kardiologian yksikkö
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, III kirurgian klinikka
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, Department of Surgery
Date: 2020-12
Language: eng
Number of pages: 8
Belongs to series: Scandinavian Journal of Surgery
ISSN: 1457-4969
URI: http://hdl.handle.net/10138/319495
Abstract: Background and Aims: Circulatory arrest carries a high risk of neurological damage, but modern monitoring methods lack reliability, and is susceptible to the generalized effects of both anesthesia and hypothermia. The objective of this prospective, explorative study was to research promising, reliable, and noninvasive methods of neuromonitoring, capable of predicting neurological outcome after hypothermic circulatory arrest. Materials and Methods: Thirty patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta were recruited in a single center and over the course of 4 years. Neuromonitoring was performed with a four-channel electroencephalogram montage and a near-infrared spectroscopy monitor. All data were tested off-line against primary neurological outcome, which was poor if the patient suffered a significant neurological complication (stroke, operative death). Results: A poor primary neurological outcome seen in 10 (33%) patients. A majority (63%) of the cases were emergency surgery, and thus, no neurological baseline evaluation was possible. The frontal hemispheric asymmetry of electroencephalogram, as measured by the brain symmetry index, predicted primary neurological outcome with a sensitivity of 79 (interquartile range; 62%-88%) and specificity of 71 (interquartile range; 61%-84%) during the first 6 h after end of circulatory arrest. Conclusion: The hemispheric asymmetry of frontal electroencephalogram is inherently resistant to generalized dampening effects and is predictive of primary neurological outcome. The brain symmetry index provides an easy-to-use, noninvasive neuromonitoring method for surgery of the thoracic aorta and postoperative intensive care.
Subject: Brain symmetry index
circulatory arrest
electroencephalogram
near-infrared spectroscopy
neuromonitoring
SELECTIVE CEREBRAL PERFUSION
EEG
BRAIN
OXYGENATION
BSI
3126 Surgery, anesthesiology, intensive care, radiology
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