The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass - A comparison of two systems of cardiopulmonary bypass

Bennett, Mark J.; Weatherall, M.; Webb, Gerry; Dudnikov, SF; Lloyd, CT

doi:10.1177/0267659114548256

Cited by 7 publications

(4 citation statements)

References 12 publications

(19 reference statements)

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“…A previous meta-analysis demonstrated a significant reduction in the incidence of stroke between the MCPB and CCPB groups[ 9 ] and the MCPB has been previously shown to have improved cerebral perfusion and reduced overall inflammation as compared to CCPB with neurocognitive outcomes. [ 16 17 18 ] However, we found that there was no significant difference for POCD between the two groups. This could be due to a number of reasons.…”

Section: Discussioncontrasting

confidence: 52%

Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial

Chew

Ang

et al. 2020

Ann Card Anaesth

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Background: Neurocognitive dysfunction is a common complication of coronary artery bypass grafting (CABG) with incidence of 19–38%. The miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce hemodilution and inflammation and provides better cerebral protection than conventional cardiopulmonary bypass (CCPB). In a meta-analysis, MCPB was associated with a 10-fold reduction in the incidence of strokes. However, its effect on postoperative cognitive decline (POCD) is unknown. We assessed if MCPB decreases POCD after CABG and compared the risk factors. Methods: A total of 71 Asian patients presenting for elective CABG at a tertiary center were enrolled. They were randomly assigned to MCPB ( n = 36) or CCPB group ( n = 35) and followed up in a single-blinded, prospective, randomized controlled trial. The primary outcome was POCD as measured by the repeatable battery of neuropsychological status (RBANS). Inflammatory markers (tumor necrosis factor-alpha and interleukin-6), hematocrit levels, and neutron-specific enolase (NSE) levels were studied. Results: Overall, the incidence of POCD at 3 months was 50%, and this was not significantly different between both groups (51.4 vs 50.0%, P = 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95% confidence interval (CI) = 1.054–8.618, P = 0.040] was significantly associated with POCD in the CCPB group, while the lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR = 0.931, 95% CI = 0.868–0.998, P = 0.044). The postoperative inflammatory markers and NSE levels were similar between the two groups. Conclusions: This study shows that the MCPB was not superior to CCPB with cell salvage and biocompatible tubing with regard to the neurocognitive outcomes measured by the RBANS.

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Section: Discussioncontrasting

confidence: 52%

Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial

Chew

Ang

et al. 2020

Ann Card Anaesth

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“…Bennett and his colleagues came to the conclusion that in conventional CPB, the reason for cerebral desaturation was the failure to achieve the target of the blood flow rate. [10] In the same study, when using mini-CPB, the most important parameter was the haemoglobin concentration. Furthermore, a major complication that is associated with cerebral hypoperfusion is the postoperative cognitive decline (POCD) after CPB.…”

Section: Blood Flow During Cpb: Goals and Requirementsmentioning

confidence: 95%

Advanced Perfusion Techniques - Flow versus Pressure

Pappa¹,

Theodosiadis²,

Paliouras³

et al. 2017

J. Biomed

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Cardiac operations which require Cardiopulmonary bypass (CPB) are considered the most common procedures in cardiac surgery, performed for more than half a century, especially in Europe and North America. Despite that new technologies are being incorporated in CPB as long as the development of new techniques in CPB, some debates still remain. These debates regard the achievement of the needed optimal perfusion during CPB and the relation between perfusion pressures and the optimal blood flow during extracorporeal circulation. Blood flow and blood pressure during Cardiopulmonary bypass are very important factors. Although more studies are in favor of a minor superiority of the optimal blood flow requirements, compared to the corresponding optimal blood pressure needs, their role is quite interdependent. The usage of contemporary electronic Data Management Systems (DMS) led to a significant evolution of the perfusion science. Adequate perfusion can now be judged by its results in real time, while information from DMS, such as venous saturation, levels of haemoglobin and lactate, may be used as the markers of optimal perfusion and additionally for the development of the perfusion protocols in the future.

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“…Nowadays, NIRS is widely used as a monitoring in surgical patients. It is used during cardiopulmonary bypass to monitor cerebral circulation [ 23 ]. It was also used to monitor the effect of hypotension induced by anesthesia induction [ 24 ] and the effects of different vasopressors used to correct this hypotension on brain circulation [ 24 , 25 ].…”

Section: Current Status Of Knowledgementioning

confidence: 99%

Near-infrared spectrometry in pregnancy: progress and perspectives, a review of literature

et al. 2016

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Near-infrared spectroscopy (NIRS) allows continuous noninvasive monitoring of in vivo oxygenation in selected tissues. It has been used primarily as a research tool for several years, but it is seeing wider application in the clinical arena all over the world. It was recently used to monitor brain circulation in cardiac surgery, carotid endarteriectomy, neurosurgery and robotic surgery. According to the few studies used NIRS in pregnancy, it may be helpful to assess the impact of severe forms of preeclampsia on brain circulation, to evaluate the efficacy of different treatments. It may also be used during cesarean section to detect earlier sudden complications. The evaluation of placental function via abdominal maternal approach to detect fetal growth restriction is a new field of application of NIRS.

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The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass - A comparison of two systems of cardiopulmonary bypass

Cited by 7 publications

References 12 publications

Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial

Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial

Advanced Perfusion Techniques - Flow versus Pressure

Near-infrared spectrometry in pregnancy: progress and perspectives, a review of literature

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