The effects of cardiopulmonary bypass temperature on neuropsychologic outcome after coronary artery operations: a prospective randomized trial.
The effect of systemic perfusion temperature on postoperative cognitive function was investigated in 96 adult patients undergoing elective coronary revascularization with cardiopulmonary bypass at 28 degrees C, 32 degrees C, or 37 degrees C. Neuropsychologic performance was assessed 1 day before the operation and 6 weeks after the operation. Five tests were adapted from the Wechsler Adult Intelligence Scale and two from the Wechsler Memory Scale.


RESULTS
No patients had major neurologic complications. Ninety-three patients completed the five Wechsler Adult Intelligence Scale tests, but only 70 went on to complete the Wechsler Memory Scale tests as well. In these, there was an effect of cardiopulmonary bypass temperature on the number of neuropsychologic tests in which there was a preoperative to postoperative deterioration (p = 0.021), the number with bypass at 37 degrees C being significantly greater than the number with bypass at 32 degrees C (p = 0.015). Subsidiary analyses using a multivariate linear model examined the effect of cardiopulmonary bypass temperature on the magnitude of change, with or without allowing for other possible confounding influences. There was an adverse effect of normothermic (37 degrees C) versus moderately hypothermic (32 degrees C) perfusion---more convincingly displayed in the analyses of all seven scores rather than just the Wechsler Adult Intelligence Scale scores. Further cooling to 28 degrees C conferred no additional benefit in terms of cognitive function. The importance of the deterioration is open to question.
Regragui
I
I
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, United Kingdom.
Birdi
I
I
Izzat
M B
MB
Black
A M
AM
Lopatatzidis
A
A
Day
C J
CJ
Gardner
F
F
Bryan
A J
AJ
Angelini
G D
GD
D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D001026:Coronary Artery Bypass; D005260:Female; D006304:Health Status; D006801:Humans; D007036:Hypothermia, Induced; D007361:Intelligence Tests; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011446:Prospective Studies