Overview

 

Cerebral Desaturation during Cardiac Surgery is Common, Costly, and Debilitating.

Cerebral desaturation is a common occurrence during cardiac surgery that may adversely affect clinical outcome[1] and the cost of care.[2]

  • Up to 37% of patients experience cerebral desaturation during cardiac surgery[3]
    • Three quarters of patients experience cerebral desaturation during high-risk cardiac surgery[4]
    • A greater degree of intraoperative cerebral desaturation is associated with:
      • Increased incidence of postoperative cognitive dysfunction[5]
      • Increased incidence of postoperative delirium[6]
      • Increased hospital length of stay in high risk patients[7]
      • Increased ICU length of stay in high risk patients[7]
  • The INVOS cerebral/somatic oximeter provides clinicians with a trend of intraoperative regional cerebral oxygenation. The data obtained from rSO2 monitoring may be used to reverse decreasing cerebral perfusion and avert prolonged cerebral desaturation.[4]
  • INVOS-guided detection and correction of cerebral desaturation may assist clinicians in improving patient outcomes.[1]
  • Compared to controls, INVOS-guided reduction of cerebral desaturation:
    • Reduced mean cerebral desaturation time by 39%[8]
    • Reduced permanent stroke by 51.74%[9]
    • Reduced the incidence of prolonged postoperative mechanical ventilation by 35.85%[9]
    • Reduced ICU length of stay by 30.74%[1]
    • Reduced post-operative cognitive decline by 46.15%[10]
    • Reduced major organ morbidity and mortality by 72.72%[1]
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  • The INVOS cerebral/somatic oximeter provides clinicians with a trend of intraoperative regional cerebral oxygenation. The data obtained from rSO2 monitoring may be used to reverse decreasing cerebral perfusion and avert prolonged cerebral desaturation.[4]
  • INVOS-guided detection and correction of cerebral desaturation may assist clinicians in improving patient outcomes.[1]
  • Compared to controls, INVOS-guided reduction of cerebral desaturation:
    • Reduced mean cerebral desaturation time by 39%[8]
    • Reduced permanent stroke by 51.74%[9]
    • Reduced the incidence of prolonged postoperative mechanical ventilation by 35.85%[9]
    • Reduced ICU length of stay by 30.74%[1]
    • Reduced post-operative cognitive decline by 46.15%[10]
    • Reduced major organ morbidity and mortality by 72.72%[1]

Key Resources:

References:

1. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia and analgesia. 2007;104(1):51-58. [ View Abstract ]

2. Goldman SM, Sutter FP, Wertan MA, Ferdinand FD, Trace CL, Samuels LE. Outcome improvement and cost reduction in an increasingly morbid cardiac surgery population. Semin Cardiothorac Vasc Anesth. 2006;10(2):171-175. [ View Abstract ]

3. Schoen J, Husemann L, Tiemeyer C, et al. Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. British journal of anaesthesia. 2011;106(6):840-850. [ View Abstract ]

4. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266. [ View Abstract ]

5. de Tournay-Jette E, Dupuis G, Bherer L, Deschamps A, Cartier R, Denault A. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. Journal of cardiothoracic and vascular anesthesia. 2011;25(1):95-104. [ View Abstract ]

6. Schoen J, Meyerrose J, Paarmann H, Heringlake M, Hueppe M, Berger KU. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care. 2011;15(5):R218. [ View Abstract ]

7. Schön J, Serien V, Heinze H, et al. Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery. Appl Cardiopulm Pathophysiol. 2009;13:201-207. [ View Abstract ]

8. Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart, lung & circulation. 2014;23(1):68-74. [ View Abstract ]

9. Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. The heart surgery forum. 2004;7(5):E376-381. [ View Abstract ]

10. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2015 Mar;47(3):447-54.
[ View Abstract ]

*Covidien, INVOS™ Cerebral/Somatic Oximetry Clinical Evidence Bibliography–Cardiac Surgery, 13-PM-0290_STL, 2013.

 

Incidence

 

The intraoperative incidence of cerebral desaturation is influenced by the definition of desaturation and surgical procedure. The table below summarizes the literature investigating the incidence of cerebral desaturation across multiple definitions and procedures.

 
 
 

Citation

Procedure

Temperature

Definition

N

Incidence

Alassar 20151

Valve

Normothremia

rSO2 < 50%

127

41.50%

Colak 20122

CABG

Hypothermia

area under the curve >150 min% for rSO2 <20% of baseline or >50 min% for rSO2 <50%

58

31%

Cook 19943

CABG

Hypothermia

SjvO2 value below 50%

26

12%

Cook 19943

CABG

Normothermia

SjvO2 value below 50%

26

54%

Deschamps 20134

CABG, Valve, Multiple Valve, Valvular and Aortic surgery

n/a

rSO2 decrease >20% from baseline for 15 seconds

279

48.80%

Diephuis 20055

OPCABG

Normothermia

SjvO2 value below 50%

87

27%

Diephuis 20055

CABG

Hypothermia

SjvO2 value below 50%

100

17%

Kadoi 19996

CABG

Hypothermia

SjvO2 value below 50%

15

33%

Kadoi 19996

CABG

Normothermia

SjvO2 value below 50%

15

66%

Kadoi 20017

CABG

Normothermia

SjvO2 value below 50%

185

44%

Kadoi 20038

CABG

Normothermia

SjvO2 value below 50%

180

57%

Kadoi 20049

CABG

Normothermia

SjvO2 value below 50%

30

40%

Kadoi 20049

CABG

Hypothermia

SjvO2 value below 50%

30

7%

Miura 200910

OPCABG

Normothermia

SjvO2 value below 50%

43

77%

Moritz 201011

OPCABG

Normothermia

rSO2 decrease >20% from baseline

35

20%

Reents 200212

CABG

Hypothermia

rSO2 < 40% or a > 25% decrease from baseline

47

36%

Schoen 200913

CABG, Valve

Normothermia

rSO2 < 50%

274

24%

Schon 200914

Aortic surgery

Hypothermia

rSO2 <80%

51

22%

Yao 200415

CABG, Valve

Hypothermia

rSO2 <35%

101

36%

 
Acronyms

CABG

Coronary Artery Bypass Graft

OPCABG

Off-pump Coronary Artery Bypass Graft

rSO2

Regional hemoglobin oxygen saturation

SjvO2

Jugular venous oxygen saturation

References:

1. Alassar A, Soppa G, Edsell M, et al. Incidence and Mechanisms of Cerebral Ischemia After Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement. The Annals of thoracic surgery. 2015. [ View Abstract ]

2. Colak Z, Borojevic M, Ivancan V, Gabelica R, Biocina B, Majeric-Kogler V. The relationship between prolonged cerebral oxygen desaturation and postoperative outcome in patients undergoing coronary artery bypass grafting. Collegium antropologicum. 2012;36(2):381-388. [ View Abstract ]

3. Cook DJ, Oliver WC, Jr., Orszulak TA, Daly RC. A prospective, randomized comparison of cerebral venous oxygen saturation during normothermic and hypothermic cardiopulmonary bypass. The Journal of thoracic and cardiovascular surgery. 1994;107(4):1020-1028; discussion 1028-1029. [ View Abstract ]

4. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266. [ View Abstract ]

5. Diephuis JC, Moons KG, Nierich AN, Bruens M, van Dijk D, Kalkman CJ. Jugular bulb desaturation during coronary artery surgery: a comparison of off-pump and on-pump procedures. British journal of anaesthesia. 2005;94(6):715-720. [ View Abstract ]

6. Kadoi Y, Kawahara F, Saito S, et al. Effects of hypothermic and normothermic cardiopulmonary bypass on brain oxygenation. The Annals of thoracic surgery. 1999;68(1):34-39.
[ View Abstract ]

7. Kadoi Y, Saito S, Goto F, Fujita N. Decrease in jugular venous oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients. Journal of the American College of Cardiology. 2001;38(5):1450-1455. [ View Abstract ]

8. Kadoi Y, Saito S, Kunimoto F, Goto F, Fujita N. Comparative effects of propofol versus fentanyl on cerebral oxygenation state during normothermic cardiopulmonary bypass and postoperative cognitive dysfunction. The Annals of thoracic surgery. 2003;75(3):840-846. [ View Abstract ]

9. Kadoi Y, Saito S, Takahashi K, Fujita N, Goto F. Jugular venous oxygen saturation during mild hypothermic versus normothermic cardiopulmonary bypass in elderly patients. Surgery today. 2004;34(5):399-404. [ View Abstract ]

10. Miura N, Yoshitani K, Kawaguchi M, et al. Jugular bulb desaturation during off-pump coronary artery bypass surgery. Journal of anesthesia. 2009;23(4):477-482. [ View Abstract ]

11. Moritz S, Rochon J, Volkel S, et al. Determinants of cerebral oximetry in patients undergoing off-pump coronary artery bypass grafting: an observational study. European journal of anaesthesiology. 2010;27(6):542-549. [ View Abstract ]

12. Reents W, Muellges W, Franke D, Babin-Ebell J, Elert O. Cerebral oxygen saturation assessed by near-infrared spectroscopy during coronary artery bypass grafting and early postoperative cognitive function. The Annals of thoracic surgery. 2002;74(1):109-114. [ View Abstract ]

13. Schön J, Serien V, Hanke T, et al. Cerebral oxygen saturation monitoring in on-pump cardiac surgery – A 1 year experience. Appl Cardiopulm Pathophysiol. 2009;13:243-252. [ View Abstract ]

14. Schön J, Serien V, Heinze H, et al. Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery. Appl Cardiopulm Pathophysiol. 2009;13:201-207. [ View Abstract ]

15. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2004;18(5):552-558. [ View Abstract ]

 

Complications

 

An increased perioperative incidence of cerebral desaturation places patients at increased risk for postoperative complications and additional intraoperative interventions.

Figure 1. Hospital Length of Stay (LOS) (D) in high risk patients (Euroscore <=8) with nadir rSO2 <50% vs nadir rSO2 > 50% (p=0.008)1[-][+]

Figure 2. Duration on ICU (hrs) in high risk patients (Euroscore <=8) with nadir rSO2 <50% vs nadir rSO2 > 50% (p=0.008)1[-][+]

Figure 3. Percentage of patients requiring blood transfusions as an intervention in patients with or without cerebral prolonged desaturation (p <0.001)2[-][+]

Figure 4. Mean number of intraoperative interventions in patients with or without prolonged desaturation (p <0.001)2[-][+]

Figure 5. Mean blood during CPB – ml in patients with or without prolonged desaturation (p=0.007)2[-][+]

Figure 6. Pulmonary complications (%) in high risk patients (Euroscore <=8) with nadir rSO2 <50% vs nadir rSO2 > 50% (p=0.008)1[-][+]

Figure 7. Area under the curve (min%) with rSO2 < 50% in patients with and without Postoperative Delirium (p<0.001)3[-][+]

Figure 8. Percentage of patients with vs. without late POCD with rSO2 <30% of Baseline (p=0.03)4[-][+]

Figure 9. Percentage of Patients with AEMT Impairment with nadir rSO2 <35% vs nadir rSO2 > 35% (p<0.001)5[-][+]

Figure 10. Percentage of Patients with Mini Mental State Examination (MMSE) Impairment with nadir rSO2 <35% vs nadir rSO2 > 35% (p=0.002)5[-][+]

References:

1. Schön J, Serien V, Heinze H, et al. Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery. Appl Cardiopulm Pathophysiol. 2009;13:201-207. [ View Abstract ]

2. Colak Z, Borojevic M, Ivancan V, Gabelica R, Biocina B, Majeric-Kogler V. The relationship between prolonged cerebral oxygen desaturation and postoperative outcome in patients undergoing coronary artery bypass grafting. Collegium antropologicum. 2012;36(2):381-388. [ View Abstract ]

3. Schoen J, Meyerrose J, Paarmann H, Heringlake M, Hueppe M, Berger KU. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care. 2011;15(5):R218. [ View Abstract ]

4. de Tournay-Jette E, Dupuis G, Bherer L, Deschamps A, Cartier R, Denault A. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. Journal of cardiothoracic and vascular anesthesia. 2011;25(1):95-104. [ View Abstract ]

5. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2004;18(5):552-558. [ View Abstract ]

 

Etiology and Interventions

 

Cerebral desaturation results from an imbalance between cerebral oxygen supply and demand resulting from either limited cerebral blood supply, inadequate oxygen content, or unmet cerebral metabolic demand.
 

The etiology of cerebral desaturation during cardiac surgery is likely multifactorial, involving many patient-specific comorbidities or clinical scenarios that influence the balance between cerebral oxygen supply and demand. The most common factors leading to cerebral desaturation can be categorized as contributing to one of three processes that lead to imbalances between cerebral oxygen supply and demand: limited cerebral blood supply, inadequate oxygen content, and unmet cerebral metabolic demand. Without real-time recognition and intervention to eliminate such imbalances, hypoxic/ischemic injury may result.
 

Cerebral oxygenation and perfusion can be monitored continuously and noninvasively during cardiac surgery utilizing the INVOS cerebral/somatic oximeter. In the event of cerebral desaturation, several interventions are possible for clinicians to correct a decrease in rSO2 values. These interventions target the optimization of those mechanisms that influence cerebral blood supply, inadequate oxygen content, and unmet cerebral metabolic demand.

 
Table 1. Causes of intraoperative cerebral desaturation during cardiac surgery and related interventions
  Condition Definition Common Causes
Limited cerebral blood supply Mechanical Obstruction to Cerebral Blood Causes of mechanical obstructions to cerebral blood flow include circumstance that limit arterial inflow or venous outflow.
Cerebral Hypoperfusion Cardiac output, autoregulation, partial pressure of carbon dioxide, and mean arterial pressure all play a role in determine cerebral perfusion.
Inadequate oxygen content Hypoventilation Failed oxygen delivery may result in injury despite constant hemodynamics.
Anemia Anemia may result in inadequate oxygen delivery or increase embolic load during cardiac surgery, increasing the potential for ischemic cerebral injury.2
Unmet cerebral metabolic demand Increased cerebral metabolic rate of oxygen Increased cerebral metabolic rate may contribute to an imbalance between cerebral oxygen supply and demand, potentially resulting in hypoxic/ischemic neurological injury.

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References:

1. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266. [ View Abstract ]

2. Karkouti K, Djaiani G, Borger MA, et al. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery. The Annals of thoracic surgery. 2005;80(4):1381-1387. [ View Abstract ]

3. Harrington DK, Ranasinghe AM, Shah A, Oelofse T, Bonser RS. Recommendations for haemodynamic and neurological monitoring in repair of acute type a aortic dissection. Anesthesiology research and practice. 2011;2011:949034. [ View Abstract ]

4. Bonser RS, Ranasinghe AM, Loubani M, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. Journal of the American College of Cardiology. 2011;58(24):2455-2474. [ View Abstract ]

5. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2007;32(2):255-262. [ View Abstract ]

6. Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2013;43(4):820-826. [ View Abstract ]

7. Rubio A, Hakami L, Munch F, Tandler R, Harig F, Weyand M. Noninvasive control of adequate cerebral oxygenation during low-flow antegrade selective cerebral perfusion on adults and infants in the aortic arch surgery. J Card Surg. 2008;23(5):474-479. [ View Abstract ]

8. Orihashi K, Sueda T, Okada K, Imai K. Malposition of selective cerebral perfusion catheter is not a rare event. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2005;27(4):644-648. [ View Abstract ]

9. Moritz S, Rochon J, Volkel S, et al. Determinants of cerebral oximetry in patients undergoing off-pump coronary artery bypass grafting: an observational study. European journal of anaesthesiology. 2010;27(6):542-549. [ View Abstract ]

10. Talpahewa SP, Ascione R, Angelini GD, Lovell AT. Cerebral cortical oxygenation changes during OPCAB surgery. The Annals of thoracic surgery. 2003;76(5):1516-1522; discussion 1522. [ View Abstract ]

11. Murkin JM. Hemodynamic changes during cardiac manipulation in off-CPB surgery: relevance in brain perfusion. The heart surgery forum. 2002;5(3):221-224. [ View Abstract ]

12. Williams JB, Peterson ED, Wojdyla D, et al. Central venous pressure after coronary artery bypass surgery: does it predict postoperative mortality or renal failure? Journal of critical care. 2014;29(6):1006-1010. [ View Abstract ]

13. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11(4):274-281.
[ View Abstract ]

14. Kadoi Y, Kawauchi C, Kuroda M, et al. Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus. Journal of anesthesia. 2011;25(5):641-647. [ View Abstract ]

15. Abdul Aziz KA, Meduoye A. Is pH-stat or alpha-stat the best technique to follow in patients undergoing deep hypothermic circulatory arrest? Interact Cardiovasc Thorac Surg. 2010;10(2):271-282. [ View Abstract ]

16. Halstead JC, Spielvogel D, Meier DM, et al. Optimal pH strategy for selective cerebral perfusion. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2005;28(2):266-273; discussion 273 [ View Abstract ]

17. Akca O, Sessler DI, Delong D, Keijner R, Ganzel B, Doufas AG. Tissue oxygenation response to mild hypercapnia during cardiopulmonary bypass with constant pump output. British journal of anaesthesia. 2006;96(6):708-714. [ View Abstract ]

18. Patel RL, Turtle MR, Chambers DJ, James DN, Newman S, Venn GE. Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. The Journal of thoracic and cardiovascular surgery. 1996;111(6):1267-1279. [ View Abstract ]

19. Heringlake M, Garbers C, Kabler JH, et al. Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery. Anesthesiology. 2011;114(1):58-69. [ View Abstract ]

20. Ogoh S, Brothers RM, Barnes Q, et al. The effect of changes in cardiac output on middle cerebral artery mean blood velocity at rest and during exercise. The Journal of physiology. 2005;569(Pt 2):697-704.

21. Boeken U, Litmathe J, Feindt P, Gams E. Neurological complications after cardiac surgery: risk factors and correlation to the surgical procedure. The Thoracic and cardiovascular surgeon. 2005;53(1):33-36. [ View Abstract ]

22. Joshi B, Ono M, Brown C, et al. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesthesia and analgesia. 2012;114(3):503-510.

23. Joshi B, Brady K, Lee J, et al. Impaired autoregulation of cerebral blood flow during rewarming from hypothermic cardiopulmonary bypass and its potential association with stroke. Anesthesia and analgesia. 2010;110(2):321-328.

24. Ono M, Joshi B, Brady K, et al. Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke. British journal of anaesthesia. 2012;109(3):391-398.

25. Hori D, Brown C, Ono M, et al. Arterial pressure above the upper cerebral autoregulation limit during cardiopulmonary bypass is associated with postoperative delirium. British journal of anaesthesia. 2014;113(6):1009-1017. [ View Abstract ]

26. Ono M, Brady K, Easley RB, et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. The Journal of thoracic and cardiovascular surgery. 2014;147(1):483-489.

27. Gottesman RF, Sherman PM, Grega MA, et al. Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome. Stroke. 2006;37(9):2306-2311. [ View Abstract ]

28. Sessler DI. Pulse oximetry may not reliably assess peripheral perfusion. Anesthesiology. 1998;88(4):1129; author reply 1130. [ View Abstract ]

29. Shah N, Trivedi NK, Clack SL, Shah M, Shah PP, Barker S. Impact of hypoxemia on the performance of cerebral oximeter in volunteer subjects. Journal of neurosurgical anesthesiology. 2000;12(3):201-209. [ View Abstract ]

30. Picton P, Chambers J, Shanks A, Dorje P. The influence of inspired oxygen fraction and end-tidal carbon dioxide on post-cross-clamp cerebral oxygenation during carotid endarterectomy under general anesthesia. Anesth Analg. 2010;110(2):581-587. [ View Abstract ]

31. Mejak BL, Stammers A, Rauch E, Vang S, Viessman T. A retrospective study on perfusion incidents and safety devices. Perfusion. 2000;15(1):51-61. [ View Abstract ]

32. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? The Journal of thoracic and cardiovascular surgery. 2003;125(6):1438-1450. [ View Abstract ]

33. McCusker K, Chalafant A, de Foe G, Gunaydin S, Vijay V. Influence of hematocrit and pump prime on cerebral oxygen saturation in on-pump coronary revascularization. Perfusion. 2006;21(3):149-155. [ View Abstract ]

34. Torella F, McCollum CN. Regional haemoglobin oxygen saturation during surgical haemorrhage. Minerva Med. 2004;95(5):461-467. [ View Abstract ]

35. Han SH, Bahk JH, Kim JH, et al. The effect of esmolol-induced controlled hypotension in combination with acute normovolemic hemodilution on cerebral oxygenation. Acta anaesthesiologica Scandinavica. 2006;50(7):863-868.

36. Mathew JP, Mackensen GB, Phillips-Bute B, et al. Effects of extreme hemodilution during cardiac surgery on cognitive function in the elderly. Anesthesiology. 2007;107(4):577-584. [ View Abstract ]

37. Kawahara F, Kadoi Y, Saito S, Goto F, Fujita N. Slow rewarming improves jugular venous oxygen saturation during rewarming. Acta anaesthesiologica Scandinavica. 2003;47(4):419-424. [ View Abstract ]

38. Grigore AM, Murray CF, Ramakrishna H, Djaiani G. A core review of temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter? Anesthesia and analgesia. 2009;109(6):1741-1751. [ View Abstract ]

39. Alkire MT. Quantitative EEG correlations with brain glucose metabolic rate during anesthesia in volunteers. Anesthesiology. 1998;89(2):323-333. [ View Abstract ]

 

Outcomes

 

INVOS guided detection and correction of cerebral desaturation may assist clinicians in reducing the perioperative incidence and depth of cerebral desaturation and improving postoperative outcome.

Figure 1. Mean Desaturation Time (min), INVOS group vs control (p<0.001)1[-][+]

Figure 2. Mean Desaturation Load* in the operating room (OR), INVOS group vs. control (p=0.041)2[-][+]

Figure 3. Mean Desaturation Load* in the Intensive Care Unit, INVOS group vs. controls (p=0.030)2[-][+]

Figure 4. Permanent Stroke (%), INVOS group vs control (p < 0.044)3[-][+]

Figure 5. Percentage of patients who required prolonged ventilation, INVOS group vs control (p<0.0014)3[-][+]

Figure 6. ICU Length of Stay (LOS) (D), INVOS group vs control. (p=0.029)4[-][+]

Figure 7. Total post-operative ventilator time (hrs), INVOS group vs control (p<0.0016)3[-][+]

Figure 8. Delta in S100B Concentration pre vs. postsurgery, INVOS group vs control. (p<0.001)1[-][+]

Figure 9. Post-op Cognitive Decline, INVOS group vs control. (p=0.002)5[-][+]

Figure 10. Major organ morbidity and mortality(%), INVOS Group vs. Control. (p=0.048)4[-][+]

Figure 11. Percentage of Patients Requiring Transfusion, INVOS Group vs. Control. (p=0.04)6[-][+]

Figure 12. Red Blood Cell (RBC) Administered per Patient, INVOS Group vs. Control. (p=0.011)6[-][+]

References:

1. Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart, lung & circulation. 2014;23(1):68-74. [ View Abstract ]

2. Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266. [ View Abstract ]

3. Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. The heart surgery forum. 2004;7(5):E376-381. [ View Abstract ]

4. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia and analgesia. 2007;104(1):51-58. [ View Abstract ]

5. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2015 Mar;47(3):447-54.
[ View Abstract ]

6. Vretzakis G, Georgopoulou S, Stamoulis K, et al. Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial. Journal of cardiothoracic surgery. 2013;8:145. [ View Abstract ]