Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing Cardiac Surgery With Electroencephalography Monitoring: A Systematic Review and Meta-Analysis

Alkhatip, Ahmed Abdelaal Ahmed Mahmoud M.; Kamel, Mohamed Gomaa; Farag, Ehab; Elayashy, Mohamed; Farag, Ahmed; Yassin, Hany Mahmoud; Bahr, Mahmoud Hussein; Abdelhaq, Mohamed; Sallam, Amr; Kamal, Ahmed; Emady, Mohamed Farid El; Wagih, Mohamed; Naguib, Amr Ahmed; Helmy, Mohamed; Algameel, Haytham Zien; Abdelkader, Mohamed; Mohamed, Hassan; Younis, Mohamed; Purcell, Andrew; Elramely, Mohamed Adly; Hamza, M

doi:10.1053/j.jvca.2021.01.039

Cited by 17 publications

(13 citation statements)

References 60 publications

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“…Multiple reviews have advocated multimodal brain monitoring combining EEG, cerebral oximetry, and transcranial Doppler ultrasound in children undergoing cardiac surgery to improve outcomes. [18][19][20][21] Initiation and separation from CPB are frequently associated with periods of hemodynamic changes or instability, 113 making it challenging to titrate anesthetics to effect. The onset of cooling and hypothermia leads to a reduction of anesthetic requirements 114 ; however, drug pharmacokinetics are also altered due to hemodilution, acid-base changes, and altered metabolism, leading to variable effect.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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Section: Anesthesia and Analgesiamentioning

confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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“…The EACTS/ESVS 2019 expert consensus document on the management of thoracic aortic and aortic arch disease identified widespread use of perioperative EEG monitoring but a lack of evidence for an incremental benefit [ 63 ]. Similarly, a systematic review and meta-analysis on outcomes in children following DHCA with EEG monitoring identified 19 studies published in English since 1990 [ 64 ]. They reported similar pooled event rates of clinical seizures (12.9%), EEG seizures (14.9%), neurological abnormalities (29.8%) and EEG abnormalities (17.3%) to our findings in adults and children.…”

Section: Discussionmentioning

confidence: 99%

Perioperative electroencephalography in cardiac surgery with hypothermic circulatory arrest: a narrative review

McDevitt

Gul

Jones

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives Cardiac surgery with hypothermic circulatory arrest is associated with neurological morbidity of variable severity and electroencephalography is a sensitive proxy measure of brain injury. We conducted a narrative review of the literature to evaluate the role of perioperative electroencephalography monitoring in cardiac surgery involving hypothermic circulatory arrest. Methods MEDLINE, EMBASE, CENTRAL and LILACS databases were searched to identify studies utilising perioperative electroencephalography during surgery with hypothermic circulatory arrest in all age groups, published since 1985 in any language. We aimed to compare electroencephalography use with no use but due to the lack of comparative studies, we performed a narrative review of its utility. Two or more reviewers independently screened studies for eligibility and extracted data. Results 40 single-centre studies with a total of 3,287 patients undergoing surgery were identified. Most were observational cohort studies (34, 85%) with only one directly comparing electroencephalography use with no use. Electroencephalography continuity (18, 45%), seizures (15, 38%), and electrocerebral inactivity prior to circulatory arrest (15, 38%) were used to detect, monitor, prevent, and prognose neurological injury. Neurological dysfunction was reported in almost all studies and occurred in 0–21% of patients. However, the heterogeneity of reported clinical and electroencephalography outcome measures prevented meta-analysis. Conclusions Electroencephalography is used to detect cortical ischaemia, seizures, predict neurological abnormalities and may guide intraoperative cerebral protection. However, there is a lack of comparative data demonstrating benefit of perioperative electroencephalography monitoring. Use of a standardised methodology for performing electroencephalography and reporting outcome metrics would facilitate the conduct of high-quality clinical trials.

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“…The rate of neurologic complication in adults who underwent aortic surgery with DHCA was 13.9% [4]. In one recent meta-analysis, the incidence of clinical and electroencephalogram seizures among pediatric patients with DHCA was 12.9% and 14.9%, Ivyspring International Publisher respectively [5]. Neurologic abnormalities occurring after DHCA remain a significant concern.…”

Section: Introductionmentioning

confidence: 99%

Transcriptomic Profiling of circRNAs in rat Hippocampus after Deep Hypothermic Circulatory Arrest

Wang¹,

Yan²,

Pei³

et al. 2023

Int. J. Med. Sci.

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Neurologic abnormalities occurring after deep hypothermic circulatory arrest (DHCA) remain a significant concern. However, molecular mechanisms leading to DHCA-related cerebral injury are still ill-defined. Circular RNAs (circRNAs) are a class of covalently closed non-coding RNAs and can play important roles in different types of cerebral injury. This study aimed to investigate circRNAs expression profiles in rat hippocampus after DHCA and explore the potential functions of circRNAs in DHCA-related cerebral injury. Hence, the DHCA procedure in rats was established and a transcriptomic profiling of circRNAs in rat hippocampus was done. As a result, a total of 35192 circRNAs were identified. Among them, 339 circRNAs were dysregulated, including 194 down-regulated and 145 up-regulated between DHCA and sham group. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed based on the host genes of all dysregulated circRNAs. Also, 4 circRNAs were validated by RT-qPCR (rno_circ_0028462, rno_circ_0037165, rno_circ_0045161 and rno_circ_0019047). Then a circRNA-microRNA (miRNA) interaction network involving 4 candidate circRNAs was constructed. Furthermore, functional enrichment analysis of the miRNA-targeting mRNAs of every candidate circRNA was conducted to gain insight into each of the 4 circRNAs. Our study provided a better understanding of circRNAs in the mechanisms of DHCA-related cerebral injury and some potential targets for neuroprotection.

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Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing Cardiac Surgery With Electroencephalography Monitoring: A Systematic Review and Meta-Analysis

Cited by 17 publications

References 60 publications

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Perioperative electroencephalography in cardiac surgery with hypothermic circulatory arrest: a narrative review

Transcriptomic Profiling of circRNAs in rat Hippocampus after Deep Hypothermic Circulatory Arrest

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