Multimodal Brain Monitoring Reduces Major Neurologic Complications in Cardiac Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2011-12, Vol.25 (6), p.1076-1085
• Main Authors: Zanatta, Paolo, MD, Benvenuti, Simone Messerotti, MS, Bosco, Enrico, MD, Baldanzi, Fabrizio, MS, Palomba, Daniela, MD, Valfrè, Carlo, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Anesthesia, General; Brain - physiology; brain ischemia; cardiac surgery; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Critical Care; electroencephalogram; Electroencephalography; Erythrocyte Transfusion; Evoked Potentials, Somatosensory - physiology; Female; Humans; Length of Stay; Male; Monitoring, Intraoperative - methods; multimodal brain monitoring; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Nervous System Diseases - prevention & control; neurologic complications; Oxygen - blood; Plasma; Platelet Transfusion; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Respiration, Artificial; Retrospective Studies; Sample Size; somatosensory-evoked potentials; transcranial Doppler; Ultrasonography, Doppler, Transcranial
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2011.05.015

Objective Although adverse neurologic outcomes are common complications of cardiac surgery, intraoperative brain monitoring has not received adequate attention. The aim of the present study was to evaluate the effectiveness of multimodal brain monitoring in the prevention of major brain injury and reducing the duration of mechanical ventilation, intensive care unit, and postoperative hospital stays after cardiac surgery. Design A retrospective, observational, controlled study. Setting A single-center regional hospital. Participants One thousand seven hundred twenty-one patients who had undergone cardiac surgery with cardiopulmonary bypass from July 2007 to July 2010. One hundred sixty-six patients with multimodal brain monitoring and a control group without brain monitoring (N = 1,555) were compared retrospectively. Interventions Multimodal brain monitoring was performed for 166 patients, consisting of intraoperative recordings of somatosensory-evoked potentials, electroencephalography, and transcranial Doppler. Measurements and Main Results The incidence of major neurologic complications and the duration of mechanical ventilation, intensive care unit, and postoperative hospital stays were considered. Patients with brain monitoring had a significantly lower incidence of perioperative major neurologic complications (0%) than those without monitoring (4.06%, p = 0.01) and required significantly shorter periods of mechanical ventilation ( p = 0.001) and intensive care unit stays ( p = 0.01) than controls. The length of postoperative hospital stays did not differ significantly between the 2 groups ( p = 0.57). Conclusions This preliminary study suggests that multimodal brain monitoring can reduce the incidence of neurologic complications as well as hospital costs associated with post–cardiac surgery patient care. Furthermore, intraoperative brain monitoring provides useful information about brain functioning, blood flow velocity, and metabolism, which may guide the anesthesiologist during surgery.