The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization.
Several studies suggest that normothermic ("warm") bypass techniques may improve myocardial outcomes for patients undergoing cardiac operations. Normothermic temperatures during cardiopulmonary bypass may, however, decrease the brain's tolerance to the ischemic insults that accompany all cardiac procedures. To assess the effect of bypass temperature management strategy on central nervous system outcomes in patients undergoing coronary revascularization, 138 patients were randomly assigned to two treatment groups: (1) hypothermia (n = 70), patients cooled to a temperature less than 28 degrees C during cardiopulmonary bypass, or (2) normothermia (n = 68), patients actively warmed to a temperature of at least 35 degrees C. Patients underwent detailed neurologic examination before the operation, on postoperative days 1 to 3 and 7 to 10, and at approximately 1 month after operation. In addition, a battery of five neuropsychologic tests was administered before operation, on postoperative days 7 to 10, and at the 4- to 6-week follow-up visit. Patients in the normothermic treatment group were older (65 +/- 10 vs 61 +/- 11 years in the hypothermic group), had statistically less likelihood of preexisting cerebrovascular disease, and had higher bypass blood glucose values (276 +/- 100 mg/% vs. 152 +/- 66 mg/% in the hypothermic group). All other patient characteristics and intraoperative variables were similar in the two treatment groups. Seven of 68 patients in the normothermic group were found to have a central neurologic deficit, compared with none of the patients cooled to 28 degrees C (p = 0.006). Performance on at least one neuropsychologic test deteriorated in the immediate postoperative period in more than one half of all patients in both treatment groups but returned to preoperative levels approximately 1 month after the operation in most (85%). This pattern was not related to bypass temperature management strategy. We conclude that active warming during cardiopulmonary bypass to maintain systemic temperatures > or = 35 degrees C increases the risk of perioperative neurologic deficit in patients undergoing elective coronary revascularization.
Mora
C T
CT
Division of Cardiothoracic Anesthesiology, Emory University School of Medicine, Atlanta, Ga, USA.
Henson
M B
MB
Weintraub
W S
WS
Murkin
J M
JM
Martin
T D
TD
Craver
J M
JM
Gott
J P
JP
Guyton
R A
RA
D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature; D001921:Brain / Q000503:physiopathology*; D002545:Brain Ischemia / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000150:complications; D003071:Cognition / Q000502:physiology; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D007858:Learning / Q000502:physiology; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009204:Myocardial Revascularization; D009460:Neurologic Examination; D009484:Neuropsychology; D013131:Spine / Q000503:physiopathology*; D016896:Treatment Outcome
D001786:Blood Glucose