title: Neuropsychologic outcome after deep hypothermic circulatory arrest in adults.
abstract: BACKGROUND
  Pediatric patients undergoing prolonged periods of deep hypothermic circulatory arrest have been found to experience long-term deficits in cognitive function. However, there is limited information of this type in adult patients who are undergoing deep hypothermic circulatory arrest for thoracic aortic repairs.
  
  
  METHODS
  One hundred forty-nine patients undergoing elective cardiac or thoracic aortic operations were evaluated preoperatively; 106 patients were evaluated early in the postoperative period (EARLY), and 77 patients were evaluated late in the postoperative period (LATE) with a battery of neuropsychologic tests. Seventy-three patients had routine cardiac operations without deep hypothermic circulatory arrest, and 76 patients with deep hypothermic circulatory arrest were divided into 2 subgroups: those with 1 to 24 minutes of deep hypothermic circulatory arrest (n = 36 patients) and those with 25 minutes or more of deep hypothermic circulatory arrest (n = 40 patients). The neuropsychologic test battery consisted of 8 tests encompassing 5 domains: attention, processing speed, memory, executive function, and fine motor function. Data were normalized to baseline values, and changes from baseline were analyzed by analysis of covariance, multivariate logistic regression, and survival functions.
  
  
  RESULTS
  In all domains, poor performance or inability to be tested EARLY were significant predictors of poor performance LATE (odds ratio, 5.27; P <.01). Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were significant predictors of poor performance LATE for the memory and fine motor domains. Deep hypothermic circulatory arrest of 25 minutes or more (odds ratio, 4. 0; P =.02) was a determinant of prolonged hospital stay (>21 days).
  
  
  CONCLUSIONS
  Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were associated with memory and fine motor deficits and with prolonged hospital stay.
authors.affiliation: Departments of Anesthesiology, Cardiothoracic Surgery, and Rehabilitation Medicine, The Mount Sinai-New York University Medical Center, New York, NY 10029-6574, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Reich
authors.forename: S
authors.initials: S
authors.lastname: Uysal
authors.forename: M
authors.initials: M
authors.lastname: Sliwinski
authors.forename: M A
authors.initials: MA
authors.lastname: Ergin
authors.forename: R A
authors.initials: RA
authors.lastname: Kahn
authors.forename: S N
authors.initials: SN
authors.lastname: Konstadt
authors.forename: J
authors.initials: J
authors.lastname: McCullough
authors.forename: M R
authors.initials: MR
authors.lastname: Hibbard
authors.forename: W A
authors.initials: WA
authors.lastname: Gordon
authors.forename: R B
authors.initials: RB
authors.lastname: Griepp
mesh_terms: D000367:Age Factors; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009483:Neuropsychological Tests; D013997:Time Factors