Advertisement

Cardiopulmonary Bypass and the Brain

  • John C. Drummond
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 31)

Abstract

The impact of cardiopulmonary bypass (CPB) on the brain deserves discussion; the available literature suggests that stroke occurs with an incidence of 2 to 10% (1). In addition, the rate of neuropsychologic dysfunction shortly after cardiopulmonary bypass (CPB) can exceed 50%. With respect to the latter, the incidence is clearly related to the duration of testing after CPB. The metanalysis by Robinson et al. of CABG patients revealed reported rates of neuropsychologic dysfunction for the immediate post-CPB period (5–8 days) of 11–75%; of 11–40% after 6–12 weeks; and of 5% at 6 months or longer (2).

Keywords

Cerebral Blood Flow Cardiopulmonary Bypass Circulatory Arrest Jugular Bulb Deep Hypothermic Circulatory Arrest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hartman GS, Yao FS, Bruefach M, et al. Cardiopulmonary bypass at high pressure reduces stroke incidence in patients with TEE diagnosed severe aortic atheromatous disease [abstract]. Anesth Analg 80:SCA52, 1995Google Scholar
  2. 2.
    Robinson M, Blumenthal JA, Burker EJ, et al. Coronary artery bypass grafting and cognitive function: A review. J Cardiopulmonary Rehabil 10:180–9, 1990CrossRefGoogle Scholar
  3. 3.
    Wareing TH, Davila-Roman VG, Daily BB, et al. Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 55:1400–8, 1993PubMedCrossRefGoogle Scholar
  4. 4.
    Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta; an emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 103:1104–12, 1992PubMedGoogle Scholar
  5. 5.
    Wolman RL, Aggarwal A, Kanchuger M, et al. Risk factors for adverse neurologic outcome following intracardiac surgery [abstract]. Anesth Analg 80:SCA58, 1995Google Scholar
  6. 6.
    Pugsley W, Klinger L, Paschalis C, Treasure T. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke 25:1393–1399, 1994PubMedCrossRefGoogle Scholar
  7. 7.
    Challa VR, Moody DM, Troost BT. Brain embolic phenomena associated with cardiopulmonary bypass. J Neurol Sci 117:224–231, 1993PubMedCrossRefGoogle Scholar
  8. 8.
    Barbut D, Hinton RB, Szatrowski TP. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 25:2398–2402, 1994PubMedCrossRefGoogle Scholar
  9. 9.
    Stump DA, Rogers AT, Kon ND, et al. When emboli occur during coronary artery bypass graft surgery. Anesthesiology 79:A49, 1993CrossRefGoogle Scholar
  10. 10.
    Murkin JM. Neurologic dysfunction after CAB or valvular surgery: Is the medium the miscreant? [editorial]. Anesth Analg 76:213–4, 1993PubMedCrossRefGoogle Scholar
  11. 11.
    Gilman S. Cerebral disorders after open-heart operations. N Engl J Med 272:489–98, 1965PubMedCrossRefGoogle Scholar
  12. 12.
    Newman MF, Croughwell ND, Blumenthal JA, et al. Predictors of cognitive decline after cardiac operation. Ann Thorac Surg 59:1329–30, 1995Google Scholar
  13. 13.
    Shaw PJ, Bates D, Cartlidge NE, et al. An analysis of factors predisposing to neurological injury in patients undergoing coronary bypass operations. Q J Med 72:633–46, 1989PubMedGoogle Scholar
  14. 14.
    Kuroda Y, Uchimoto R, Kaieda R, et al. Central nervous system complications after cardiac surgery: A comparison between coronary artery bypass grafting and valve surgery. Anesth Analg 76:222–7, 1993PubMedCrossRefGoogle Scholar
  15. 15.
    Rogers AT, Stump DA, Gravlee GP, et al. Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass: Influence of PaCO2 management. Anesthesiology 69:547–551, 1988PubMedCrossRefGoogle Scholar
  16. 16.
    Prough DS, Rogers AT, Stump DA, et al. Hypercarbia depresses cerebral oxygen consumption during cardiopulmonary bypass. Stroke 21:1162–6, 1990PubMedCrossRefGoogle Scholar
  17. 17.
    Stephan H, Weyland A, Kazmaier S, Henze T, Menck S, Sonntag H. Acid-base management during hypothermic cardiopulmonary bypass does not affect cerebral metabolism but does affect blood flow and neurological outcome. Br J Anaesth 69:51–57, 1992PubMedCrossRefGoogle Scholar
  18. 18.
    Venn GE, Patel RL, Chambers DJ. Cardiopulmonary bypass: perioperative cerebral blood flow and postoperative cognitive deficit. Ann Thorac Surg 59:1331–5, 1995PubMedCrossRefGoogle Scholar
  19. 19.
    Govier AV, Reves JG, McKay RD, et al. Factors and their influence on regional cerebral blood flow during nonpulsatile cardiopulmonary bypass. Ann Thor Surg 38:592–600, 1984CrossRefGoogle Scholar
  20. 20.
    Greeley WJ, Ungerleider RM, Smith LR, Reves JG. The effects of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg 97:737–45, 1989PubMedGoogle Scholar
  21. 21.
    Rogers AT, Prough DS, Roy RC, et al. Cerebrovascular and cerebral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 103:363–368, 1992PubMedGoogle Scholar
  22. 22.
    Maher J, Hachinski V. Hypothermia as a potential treatment for cerebral ischemia. Cerebrovasc Brain Metab Rev 5:277–300, 1993PubMedGoogle Scholar
  23. 23.
    Craver JM, Bufkin BL, Weintraub WS, Guyton RA. Neurologic events after coronary bypass grafting: further observations with warm cardioplegia. Ann Thorac Surg 59:1429–34, 1995PubMedCrossRefGoogle Scholar
  24. 24.
    McLean RF, Wong BI, Naylor CD, Snow WG. Cardiopulmonary bypass, temperature, and central nervous system dysfunction. Circulation 90:II-250–255, 1995Google Scholar
  25. 25.
    Cook DJ, Oliver WC, Orszulak TA, Daly RC. A prospective, randomized comparison of cerebral venous oxygen saturation during normothermic and hypothermic cardiopulmonary bypass. J Thorac Cardiovas Surg 107:1020–9, 1994Google Scholar
  26. 26.
    Buss MI, McLean RF, Wong BI, et al. Rewarming after cardiopulmonary bypass and neurological function. Anesth Analg 80:SCA50, 1995Google Scholar
  27. 27.
    Taylor KM, Bain WH, Davidson KG, Turner MA. Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients. Thorax 37:324–30, 1982PubMedCrossRefGoogle Scholar
  28. 28.
    Hickey PE, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy. Ann Thorac Surg 36:720–37, 1983PubMedCrossRefGoogle Scholar
  29. 29.
    Williams GD, Seifen AB, Lawson NW, et al. Pulsatile perfusion versus conventional high-flow nonpulsatile perfusion for rapid core cooling and rewarming of infants for circulatory arrest in cardiac operation. J Thorac Cardiovasc Surg 78:667–77, 1979PubMedGoogle Scholar
  30. 30.
    Goto M, Kudoh K, Minami S, et al. The renin-angiotensin-aldosterone system and hematologic changes during pulsatile and nonpulsatile cardiopulmonary bypass. Artifical Organs 1993;17:318–22, 1993CrossRefGoogle Scholar
  31. 31.
    Dapper F, Neppl H, Wozniak G, et al. Effects of pulsatile and nonpulsatile perfusion mode during extracorporeal circulation—a comparative clinical study. Thorac Cardiovasc Surg 40:345–51, 1992PubMedCrossRefGoogle Scholar
  32. 32.
    Hindman BJ, Dexter F, Ryu KH, Smith T, Cutkomp J. Pulsatile versus nonpulsatile cardiopulmonary bypass: No difference in brain blood flow or metabolism at 27°C. Anesthesiology 80:1137–47, 1994PubMedCrossRefGoogle Scholar
  33. 33.
    Hindman BJ, Dexter F, Smith T, Cutkomp J. Pulsatile versus nonpulsatile flow: No difference in cerebral blood flow or metabolism during normo-thermic cardiopulmonary bypass in rabbits. Anesthesiology 82:241–50, 1995PubMedCrossRefGoogle Scholar
  34. 34.
    Tranmer BI, Gross CE, Kindt GW, Adley GR. Pulsatile versus nonpulsatile blood flow in the treatment of acute cerebral ischemia. Neurosurg 731:724–31, 1986CrossRefGoogle Scholar
  35. 35.
    Dernevik L, Arvidsson S, William-Olsson G. Cerebral perfusion in dogs during pulsatile and nonpulsatile extracorporeal circulation. J Cardiovasc Surg 26:32–5, 1985Google Scholar
  36. 36.
    Sadahiro M, Haneda K, Mohri H. Experimental study of cerebral autoregulation during cardiopulmonary bypass with or without pulsaile perfusion. J Thorac Cardiovasc Surg 108:446–54, 1994PubMedGoogle Scholar
  37. 37.
    Henze T, Stephan H, Sonntag H. Cerebral dysfunction following extracorporeal circulation for aortocoronary bypass surgery: no differences in neuropsychological outcome after pulsatile versus nonpulsatile flow. Thorac Cardiovasc Surg 38:65–8, 1990PubMedCrossRefGoogle Scholar
  38. 38.
    Watanabe T, Washio M. Pulsatile low-flow perfusion for enhanced cerebral protection. Ann Thorac Surg 56:1478–81, 1993PubMedCrossRefGoogle Scholar
  39. 39.
    Watanabe T, Washio M. Cerebral cellular response to profound hypothermia. Cardiol Young 3:383–93, 1993CrossRefGoogle Scholar
  40. 40.
    Anstadt MP, Stonnington MJ, Tedder M, et al. Pulsatile reperfusion after cardiac arrest improves neurologic outcome. Ann Surg 214:478–88, 1991PubMedCrossRefGoogle Scholar
  41. 41.
    Onoe M, Mori A, Watarida S, et al. The effect of pulsatile perfusion on cerebral blood flow during profound hypothermia with total circulatory arrest. J Thorac Cardiovasc Surg 108:119–25, 1994PubMedGoogle Scholar
  42. 42.
    Anstadt MP, Tedder m, Hegde SS, et al. Pulsatile versus nonpulsatile reperfusion improves cerebral blood flow after cardiac arrest. Ann Thorac Surg 56:453–61, 1993PubMedCrossRefGoogle Scholar
  43. 43.
    Padayachee TS, Parsons S, Theobold R, et al. The effect of arterial filtration on reduction of gaseous microemboli in the middle cerebral artery during cardiopulmonary bypass. Ann Thorac Surg 45:647–9, 1988PubMedCrossRefGoogle Scholar
  44. 44.
    Carlson RG, Lande AJ, Ivey LA, et al. The Lande-Edwards membrane oxygenator for total cardiopulmonary support in 110 patients during heart surgery. Surgery 72:913–9, 1972PubMedGoogle Scholar
  45. 45.
    Muraoka R, Yokota M, Aoshima M, et al. Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. J Thorac Cardiovasc Surg 81:364–9, 1981PubMedGoogle Scholar
  46. 46.
    Blauth CI, Smith PL, Arnold JV, et al. Influence of oxygenator type on the prevalence and extent of microembolic retinal ischemia during cardiopulmonary bypass. Assessment of digital image analysis. J Thorac Cardiovasc Surg 99:61–9, 1990PubMedGoogle Scholar
  47. 47.
    Metz S, Keats AS. Benefits of a glucose-containing priming solution for cardiopulmonary bypass. Anesth Analg 72:423–34, 1991Google Scholar
  48. 48.
    Frasco P, Croughwell N, Blumenthal J, et al. Association between blood glucose level during cardiopulmonary bypass and neuropsychiatrie outcome (abstract). Anesthesiology 75:A55, 1991CrossRefGoogle Scholar
  49. 49.
    Lanier WL. Glucose management during cardiopulmonary bypass: cardiovascular and neurologic implications. Anesth Analg 72:423–7, 1991PubMedCrossRefGoogle Scholar
  50. 50.
    Bashein G, Nessly ML, Bledsoe SW, Townes BD. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia. Anesthesiology 76:878–91, 1992PubMedCrossRefGoogle Scholar
  51. 51.
    Michaels I, Sheehan J. EEG changes due to unsuspected aortic dissection during cardiopulmonary bypass. Anesth Analg 63:946–8, 1984PubMedGoogle Scholar
  52. 52.
    Edmonds HL, Griffiths LK, van der Laken J. Quantitative electroen-cephalographic monitoring during myocardial revascularization predicts postoperative disorientation and improves outcome. J Thorac Cardiovasc Surg 103:555–63, 1992PubMedGoogle Scholar
  53. 53.
    Arom KV, Cohen DE, Strobl FT. Effect of intraoperative intervention on neurological outcome based on electroencephalographic monitoring during cardiopulmonary bypass. Ann Thorac Surg 48:476–83, 1989PubMedCrossRefGoogle Scholar
  54. 54.
    Edmonds HL, Slater AD, Shields CB. Electroencephalographic monitoring during cardiac surgery [Letter]. Anesthesiology 78:208, 1993PubMedCrossRefGoogle Scholar
  55. 55.
    Chabot RJ, Gugino VE. Quantitative electroencephalographic monitoring during cardiopulmonary bypass [Letter]. Anesth 78:209–10, 1993CrossRefGoogle Scholar
  56. 56.
    Murkin JM. Monitoring cerebral oxygenation (Editorial). Can J Anaesth 41:1027–32, 1994PubMedCrossRefGoogle Scholar
  57. 57.
    Croughwell ND, Frasco PB, Blumenthal JA, et al. Warming during cardiopulmonary bypass is associated with jugular bulb desaturation. Ann Thorac Surg 52:827–32, 1992CrossRefGoogle Scholar
  58. 58.
    Nakajima T, Kuro M, Hayashi Y, Kitaguchi K, Uchida O, Takaki O. Clinical evaluation of cerebral oxygen balance during cardiopulmonary bypass: online continuous monitoring of jugular venous oxyhemoglobin saturation. Anesth Analg 74:630–5, 1992PubMedCrossRefGoogle Scholar
  59. 59.
    Croughwell ND, Newman MF, Blumenthal JA, et al. Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass. Ann Thorac Surg 58:1702–8, 1994PubMedCrossRefGoogle Scholar
  60. 60.
    Bryce R, Proper J, Cook D, W Oliver J, Orszulak T, Daly R. Comparison of oxyhemoglobin saturations determined by transcranial infrared spectroscopy and co-oximetry during hypothermic cardiopulmonary bypass [abstract]. Anesth Analg 80:S61, 1995Google Scholar
  61. 61.
    Amory D, Pan L, Asinas R, Li JK-J, Kalatzis-Manolakis E. Relationship between continuous jugular venous oxygen saturation and regional cerebral oxygen saturation during cardiac surgery [abstract]. The Annual Meeting of the Society for Cardiovascular Anesthesia 288, 1993Google Scholar
  62. 62.
    Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: Cerebral protection by a barbiturate. Anesthesiology 64:165–170, 1986PubMedCrossRefGoogle Scholar
  63. 63.
    Zaidan JR, Klochany A, Martin WM, Ziegler JS, Harless DM, Andrews RB. Effect of thiopental on neurologic outcome following coronary artery bypass grafting. Anesthesiology 74:406–411, 1991PubMedCrossRefGoogle Scholar
  64. 64.
    Forsman M, Olsnes BT, Semb G, Steen PA. Effects of nimodipine on cerebral blood flow and neuropsychological outcome after cardiac surgery. Br J Anaesth 65:514–520, 1990PubMedCrossRefGoogle Scholar
  65. 65.
    Tuman KJ, McCarthy RJ, Spiess BD, Ivankovich AD. Do calcium channel blockers decrease neurologic deficits after intracardiac operations? Anesth Analg 70:S413, 1990CrossRefGoogle Scholar
  66. 66.
    Wagenknecht LE, Furberg CD, Hammon JW, et al. Surgical bleeding: unexpected effect of a calcium antagonist. Brit Med J 310:776–7, 1995PubMedGoogle Scholar
  67. 67.
    Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T. Guidelines for carotid endarterectomy—a multidisciplinary consensus statement from the ad hoc committee. Circulation 91:566–579, 1995PubMedGoogle Scholar
  68. 68.
    Schell RM, Kern FH, Greeley WJ, Schulman SR. Cerebral blood flow and metabolism during cardiopulmonary bypass. Anesth Analg 76:849–65, 1993PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • John C. Drummond

There are no affiliations available

Personalised recommendations