Neurological Protection During Cardiopulmonary Bypass/Deep Hypothermia

Jonas, Richard A.

doi:10.1007/s002469900317

Cited by 45 publications

(24 citation statements)

References 29 publications

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“…Neurological injury during cardiac surgery also can result from global ischemia and reperfusion. 206 Children with heart disease who have a low hemoglobin concentration resulting from iron deficiency appear to have a higher risk of arterial stroke, although the precise mechanism for this risk is not known. In contrast, individuals with a markedly elevated hematocrit may be at more risk for cerebral venous thrombosis.…”

Section: Cardiac Diseasementioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

873

377

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Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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Section: Cardiac Diseasementioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

873

377

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“…[28][29][30][31][32] Haemodynamic instability and medical complications during postoperative intensive care may then have additional adverse effects on the central nervous system. 5 33 The developing brain shows great vulnerability during synaptogenesis, also known as the brain growth spurt, which in humans extends from the sixth month of gestation into the first year of life.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopment at 1 year of age in infants with congenital heart disease

Dittrich

Bührer²,

Grimmer³

et al. 2003

Heart

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Objective: To assess psychomotor development and neurological sequelae in infants after surgery for congenital heart defects. Design and setting: Single institution prospective cohort study. Patients: 90 of 112 consecutive surviving infants of less than 1 year of age, without brain anomalies, conditions, or syndromes associated with delayed mental development, who underwent cardiac surgery during an 18 month period; 20 control infants with minor or no congenital heart defects. Main outcome measures: Griffiths developmental scales and standardised neurological examination at 1 year. Results: Mean (SD) developmental quotient (DQ) in index infants was 99 (10.6), compared with 106.7 (6.6) in controls (p < 0.001). DQ was lower in infants after palliative surgery (n = 16; 88 (12.2)) than after corrective surgery (n = 74; 101.4 (8.6)) (p < 0.001). Of the 90 index infants, 24 (27%) had a DQ below 93.5 (more than 2 SD below the mean of controls). Developmental delay (DQ < 93.5) was more common after palliative surgery (10/16, 63%) than after corrective surgery (14/74, 19%) (p < 0.001). Of the 90 index infants, 29 (32%) had neurological abnormalities, compared with only one of the 20 controls (5%) (p = 0.013). Neurological abnormalities were more frequent after palliative surgery (11/16, 69%) than after corrective surgery (18/74, 24%) (p < 0.001).Conclusions: There is a considerable rate of neurodevelopmental impairment at 1 year of age in infants after cardiac surgery. Psychomotor impairment and neurological sequelae are apparently more severe in infants in whom only palliative surgery is possible.

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“…The goal of hypothermia is to supplement the preservation of vital organ function by decreasing the metabolic rate during CPB [ 166 ]. Various levels of hypothermia are utilized based on the nature of the intervention.…”

Section: Cooling and Temperature Managementmentioning

confidence: 99%