Impact of Processed Electroencephalography in Cardiac Surgery: A Retrospective Analysis

Jarry, Stéphanie; Halley, Isabelle; Calderone, Alexander; Momeni, Mona; Deschamps, Alain; Richebé, Philippe; Beaubien‐Souligny, William; Denault, André; Couture, Étienne J.

doi:10.1053/j.jvca.2022.03.030

Cited by 9 publications

(3 citation statements)

References 40 publications

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“…After approval by the local research and ethics committee (#2021–2810), a retrospective single-centre cohort study of 354 patients undergoing cardiac surgery in which routine TCD was used between February 2015 and June 2021 was conducted. For this study, two independent investigators screened a hemodynamic/echocardiographic database [ 17 , 18 ] for consecutive patients undergoing cardiac surgery with TCD monitoring. Patients undergoing non-cardiac procedures, percutaneous procedures, or left ventricular assist device insertion as the primary procedure were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

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Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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Background During cardiac surgery, transcranial Doppler (TCD) represents a non-invasive modality that allows measurement of red blood cell flow velocities in the cerebral arteries. TCD can also be used to detect and monitor embolic material in the cerebral circulation. Detection of microemboli is reported as a high intensity transient signal (HITS). The importance of cerebral microemboli during cardiac surgery has been linked to the increased incidence of postoperative renal failure, right ventricular dysfunction, and hemodynamic instability. The objective of this study is to determine whether the embolic load is associated with hemodynamic instability during cardiopulmonary bypass (CPB) separation and postoperative complications. Methods A retrospective single-centre cohort study of 354 patients undergoing cardiac surgery between December 2015 and March 2020 was conducted. Patients were divided in tertiles, where 117 patients had a low quantity of embolic material (LEM), 119 patients have a medium quantity of microemboli (MEM) and 118 patients who have a high quantity of embolic material (HEM). The primary endpoint was a difficult CPB separation. Multivariate logistic regression was used to determine the potential association between a difficult CPB separation and the number of embolic materials. Results Patients who had a difficult CPB separation had more HITS compared to patients who had a successful CPB separation (p < 0.001). In the multivariate analysis, patients with MEM decreased their odds of having a difficult CPB weaning compared to patients in the HEM group (OR = 0.253, CI 0.111–0.593; p = 0.001). In the postoperative period patients in the HEM group have a higher Time of Persistent Organ Dysfunction (TPOD), a longer stay in the ICU, a longer duration under vasopressor drugs and a higher mortality rate compared to those in the MEM and LEM groups. Conclusion The result of this study suggests that a high quantity of cerebral embolic material increases the odds of having a difficult CPB separation. Also, it seems to be associated to more complex surgery, a longer CPB time, a higher TPOD and a longer stay in the ICU. Six out of eight patients who died in this cohort were in the HEM group.

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Section: Methodsmentioning

confidence: 99%

“…Intraoperative patients’ management was the same between the 3 groups. Other monitoring techniques include the use of transesophageal echocardiography, near-infrared spectroscopy (NIRS) and processed electroencephalography (pEEG) [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Jarry,

Couture,

Beaubien-Souligny

et al. 2024

J Cardiothorac Surg

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“…Source of arterial blood pressure monitoring was noted whether the arterial line for pressure monitoring was place centrally in the femoral artery or peripherally in the radial artery. The use of continuous processed electroencephalographic (pEEG) monitoring to monitor anesthesia level was also noted [ 17 ]. Until the first 24 hours after surgery: hourly fluid balance and ICU fluid balance, maximum lactate level, and vasopressor or inotrope treatment, including the dose and duration of therapy.…”

Section: Methodsmentioning

confidence: 99%

Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

et al. 2023

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Objective To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). Methods This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression. Results A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support. Conclusions Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not.

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New Development in Brain Monitoring for Cardiac Surgery

Jarry

Couture²,

Falih³

et al. 2023

Canadian Journal of Cardiology

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Impact of Processed Electroencephalography in Cardiac Surgery: A Retrospective Analysis

Cited by 9 publications

References 40 publications

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Clinical relevance of transcranial Doppler in a cardiac surgery setting: embolic load predicts difficult separation from cardiopulmonary bypass

Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

New Development in Brain Monitoring for Cardiac Surgery

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