Prospective randomized trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery.
BACKGROUND
Despite significant advances in cardiopulmonary bypass (CPB) technology, surgical techniques, and anesthetic management, central nervous system complications occur in a large percentage of patients undergoing surgery requiring CPB. Many centers are switching to normothermic CPB because of shorter CPB and operating room times and improved myocardial protection. The authors hypothesized that, compared with normothermia, hypothermic CPB would result in superior neurologic and neurocognitive function after coronary artery bypass graft surgery.


METHODS
Three hundred patients undergoing elective coronary artery bypass graft surgery were prospectively enrolled and randomly assigned to either normothermic (35.5-36.5 degrees C) or hypothermic (28-30 degrees C) CPB. A battery of neurocognitive tests was performed preoperatively and at 6 weeks after surgery. Four distinct cognitive domains were identified and standardized using factor analysis and were then compared on a continuous scale.


RESULTS
Two hundred twenty-seven patients participated in 6-week follow-up testing. There were no differences in neurologic or neurocognitive outcomes between normothermic and hypothermic groups in multivariable models, adjusting for covariable effects of baseline cognitive function, age, and years of education, as well as interaction of these with temperature treatment.


CONCLUSIONS
Hypothermic CPB does not provide additional central nervous system protection in adult cardiac surgical patients who were maintained at either 30 or 35 degrees C during CPB.
Grigore
A M
AM
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Mathew
J
J
Grocott
H P
HP
Reves
J G
JG
Blumenthal
J A
JA
White
W D
WD
Smith
P K
PK
Jones
R H
RH
Kirchner
J L
JL
Mark
D B
DB
Newman
M F
MF
D018686:Anesthetics, Intravenous; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000379:methods*; D004522:Educational Status; D005260:Female; D005283:Fentanyl; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl