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

Abstract

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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