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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2024; 72(S 03): e7-e15
DOI: 10.1055/s-0044-1787650
Pediatric and Congenital Cardiology

Neurological Impact of Slower Rewarming during Bypass Surgery in Infants

Geeske Muehlschlegel
1   Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Baden-Württemberg, Germany
,
Rouven Kubicki 
2   Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
,
Julia Jacobs-LeVan
3   Departments of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
,
Johannes Kroll
4   Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Baden-Württemberg, Germany
,
Rolf Klemm
5   Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Baden-Württemberg, Germany
,
Frank Humburger
6   Department of Anesthesiology, University of Freiburg Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
,
Brigitte Stiller
2   Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
,
Thilo Fleck
2   Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg Bad Krozingen Freiburg Branch, Freiburg, Freiburg, Germany
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Abstract

Background Hypothermia is a neuroprotective strategy during cardiopulmonary bypass. Rewarming entailing a rapid rise in cerebral metabolism might lead to secondary neurological sequelae. In this pilot study, we aimed to validate the hypothesis that a slower rewarming rate would lower the risk of cerebral hypoxia and seizures in infants.

Methods This is a prospective, clinical, single-center study. Infants undergoing cardiac surgery in hypothermia were rewarmed either according to the standard (+1°C in < 5 minutes) or a slow (+1°C in > 5–8 minutes) rewarming strategy. We monitored electrocortical activity via amplitude-integrated electroencephalography (aEEG) and cerebral oxygenation by near-infrared spectroscopy during and after surgery.

Results Fifteen children in the standard rewarming group (age: 13 days [5–251]) were cooled down to 26.6°C (17.2–29.8) and compared with 17 children in the slow-rewarming group (age: 9 days [4–365]) with a minimal temperature of 25.7°C (20.1–31.4). All neonates in both groups (n = 19) exhibited suppressed patterns compared with 28% of the infants > 28 days (p < 0.05). During rewarming, only 26% of the children in the slow-rewarming group revealed suppressed aEEG traces (vs. 41%; p = 0.28). Cerebral oxygenation increased by a median of 3.5% in the slow-rewarming group versus 1.5% in the standard group (p = 0.9). Our slow-rewarming group revealed no aEEG evidence of any postoperative seizures (0 vs. 20%).

Conclusion These results might indicate that a slower rewarming rate after hypothermia causes less suppression of electrocortical activity and higher cerebral oxygenation during rewarming, which may imply a reduced risk of postoperative seizures.

Keywords

cardiopulmonary bypass - neurology/neurological - hypothermia/circulatory arrest - pediatric - ischemia/reperfusion


Publikationsverlauf

Eingereicht: 28. Juli 2023

Angenommen: 19. April 2024

Artikel online veröffentlicht:
23. Juni 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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