Overview

  • Mechanism of Injury
    • In off pump coronary artery bypass grafting, patient specific factors such as left ventricular dysfunction and surgical interventions such as positioning of the heart during off-pump coronary artery bypass grafting can lead to compromised cardiac output([FOOTNOTE=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.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=569318])
    • Intraoperative decreases in cardiac output are partially responsible for decreases in cerebral oxygen saturation in OPCABG1
    • Preoperative LVEF < 30% is correlated with preoperative cerebral oxygen desaturation in cardiac surgery patients([FOOTNOTE=Heringlake M, Garbers C, Kabler JH, et al. Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery. Anesthesiology. 2011;114(1):58-69.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=297759])
    • In healthy volunteers, a linear relationship exists between cardiac output and cerebral blood flow independent of cerebral autoregulation.([FOOTNOTE=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.],[ANCHOR=],[LINK=])
  • Associated Outcome
    • Boeken et al has identified left ventricular ejection fraction < 0.35 as a risk factor for perioperative neurological injury21
  • Related Intervention
Intervention % of all interventions([FOOTNOTE=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.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805152])
Increase cardiac output/pump flow 13.1