Commentary: Optimizing cerebral oxygenation in cardiac surgery: Neurocognitive and perioperative outcomes

Abstract

Larger, more adequately powered, interventional randomized controlled trials are needed to more fully examine the influence of cerebral oximetry guidance on the optimisation of both cerebral and noncerebral outcomes after cardiac surgery.

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study

“…Hence, the true association between (temporal) decreases in ScO 2 and outcome might be underemphasized in our study given that it is likely that in case of ScO 2 decreases, prompt action(s) were taken for correction, maybe even before actual desaturation occurred; e.g., in another setting in low birth weight patients (n = 59) who were randomized to receive either dopamine or epinephrine, distinct drug-related changes were seen in cerebral hemodynamics, 32 while in another study 33 intraoperative ScO 2 desaturations were linked with concomitant drops in mean arterial blood pressure. Like in adult cardiac surgery, 34 a prospective validation of the use of continuous ScO 2 monitoring-and the effects of vasopressors and/or inotropes in optimizing ScO 2 and improving outcome in CCS-is still required.…”

Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review

“…However, the use of RCT methodology with clearly defined consensus cognitive outcome measures make the findings important in the context of evaluating this modality. 86,87 The most concerning limitation of many of these studies was the nonstandardized methodology for POCD assessments, such as antisaccadic eye movement tests, Mini-Mental State Examination, and the Montreal Cognitive Assessment (MoCA). 9,43,66 This has significant ramifications for the validity of individual studies, as well as reducing the suitability for meaningful meta-analyses, and further compounded by poor standardization of the postoperative assessment periods.…”

Commentary: Neurocognitive dysfunction after cardiopulmonary bypass: Multiple modalities to rescue the microglia

“…1,2 In a recent randomized trial, targeted therapy to optimize cerebral oxygenation improved memory up to 6 months after cardiac surgery with cardiopulmonary bypass. 11,12 A future focus will likely be the systematic optimization of cardiopulmonary bypass for neurocognitive rescue. 11,12 So, where do we go from here?…”

“…11,12 A future focus will likely be the systematic optimization of cardiopulmonary bypass for neurocognitive rescue. 11,12 So, where do we go from here? This elegant study has focused attention on microglial inflammation as a potent target for cognitive rescue after cardiopulmonary bypass.…”