Synchronized Attenuation of Frontal Alpha Wave Power and Mean Arterial Pressure During Cardiopulmonary Bypass

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Stroke is a leading cause of morbidity, mortality, and disability in patients undergoing cardiac surgery. Identifying modifiable perioperative stroke risk factors may lead to improved patient outcomes. The association between the severity and duration of intraoperative hypotension and postoperative stroke in patients undergoing cardiac surgery was evaluated. Methods A retrospective cohort study was conducted of adult patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary center between November 1, 2009, and March 31, 2015. The primary outcome was postoperative ischemic stroke. Intraoperative hypotension was defined as the number of minutes spent within mean arterial pressure bands of less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after cardiopulmonary bypass. The association between stroke and hypotension was examined by using logistic regression with propensity score adjustment. Results Among the 7,457 patients included in this analysis, 111 (1.5%) had a confirmed postoperative diagnosis of stroke. Stroke was strongly associated with sustained mean arterial pressure of less than 64 mmHg during cardiopulmonary bypass (adjusted odds ratio 1.13; 95% CI, 1.05 to 1.21 for every 10 min of mean arterial pressure between 55 and 64 mmHg; adjusted odds ratio 1.16; 95% CI, 1.08 to 1.23 for every 10 min of mean arterial pressure less than 55 mmHg). Other factors that were independently associated with stroke were older age, hypertension, combined coronary artery bypass graft/valve surgery, emergent operative status, prolonged cardiopulmonary bypass duration, and postoperative new-onset atrial fibrillation. Conclusions Hypotension is a potentially modifiable risk factor for perioperative stroke. The study’s findings suggest that mean arterial pressure may be an important intraoperative therapeutic hemodynamic target to reduce the incidence of stroke in patients undergoing cardiopulmonary bypass.

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Effect of diaspirin cross-linked haemoglobin (DCLHbtm) on mean arterial pressure during cardiopulmonary bypass in swine

Transfusion Medicine ◽

10.1046/j.1365-3148.2002.00391.x ◽

2002 ◽

Vol 12 (5) ◽

pp. 311-316 ◽

Cited By ~ 3

Author(s):

R. Ferrera ◽

G. Hadour ◽

P. Chiari ◽

P. Montagna ◽

O. Jegaden ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mean Arterial Pressure ◽

Arterial Pressure

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Erratum to: Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery: study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-016-1753-y ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Anne G. Vedel

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Mean Arterial Pressure ◽

Randomised Controlled Trial ◽

Arterial Pressure ◽

Study Protocol ◽

Perfusion Pressure ◽

Controlled Trial ◽

Cerebral Complications ◽

Randomised Controlled

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Associations between mean arterial pressure during cardiopulmonary bypass and biomarkers of cerebral injury in patients undergoing cardiac surgery: secondary results from a randomized controlled trial

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa264 ◽

2020 ◽

Author(s):

Sebastian Wiberg ◽

Frederik Holmgaard ◽

Kaj Blennow ◽

Jens C Nilsson ◽

Jesper Kjaergaard ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Mean Arterial Pressure ◽

Aortic Valve ◽

Arterial Pressure ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Neuron Specific Enolase ◽

Cerebral Injury ◽

Neurological Injury

Abstract OBJECTIVES Cardiac surgery is associated with risk of cerebral injury and mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) is suggested to be associated with cerebral injury. The ‘Perfusion Pressure Cerebral Infarcts’ (PPCI) trial randomized patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement to a MAP of 40–50 or 70–80 mmHg during CPB and found no difference in clinical or imaging outcomes between the groups. We here present PPCI trial predefined secondary end points, consisting of biomarkers of brain injury. METHODS Blood was collected from PPCI trial patients at baseline, 24 and 48 h after induction of anaesthesia and at discharge from the surgical ward. Blood was analysed for neuron-specific enolase, tau, neurofilament light and the glial marker glial fibrillary acidic protein. Linear mixed models were used to analyse differences in biomarker value changes from baseline between the 2 MAP allocation groups. RESULTS A total of 193 (98%) patients were included. We found no differences in biomarker levels over time from baseline to discharge between the 2 MAP allocation groups (PNSE = 0.14, PTau = 0.46, PNFL = 0.21, PGFAP = 0.13) and the result did not change after adjustment for age, sex and type of surgery. CONCLUSIONS We found no significant differences in levels of biomarkers of neurological injury in patients undergoing elective or subacute CABG and/or aortic valve replacement randomized to either a target MAP of 40–50 mmHg or a target MAP of 70–80 mmHg during CBP.

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