OBJECTIVES: Cardiac surgery with hypothermic circulatory arrest (HCA) is associated with neurological morbidity of variable severity and electroencephalography (EEG) is a sensitive proxy measure of brain injury. We conducted a narrative review of the literature to evaluate the role of perioperative EEG monitoring in cardiac surgery involving HCA. METHODS: Medline, Embase, Central and LILACS databases were searched to identify studies utilizing perioperative EEG during surgery with HCA in all age groups, published since 1985 in any language. We aimed to compare EEG use with no use but due to the lack of comparative studies, we performed a narrative review of its utility. Two or more reviewers independently screened studies for eligibility and extracted data. RESULTS: Fourty single-centre studies with a total of 3287 patients undergoing surgery were identified. Most were observational cohort studies (34, 85%) with only 1 directly comparing EEG use with no use. EEG continuity (18, 45%), seizures (15, 38%) and electrocerebral inactivity prior to circulatory arrest (15, 38%) were used to detect, monitor, prevent and prognose neurological injury. Neurological dysfunction was reported in almost all studies and occurred in 0-21% of patients. However, the heterogeneity of reported clinical and EEG outcome measures prevented meta-analysis. CONCLUSIONS: EEG is used to detect cortical ischaemia and seizures and predict neurological abnormalities and may guide intraoperative cerebral protection. However, there is a lack of comparative data demonstrating the benefit of perioperative EEG monitoring. Use of a standardized methodology for performing EEG and reporting outcome metrics would facilitate the conduct of high-quality clinical trials.
|Number of pages||9|
|Journal||Interactive CardioVascular and Thoracic Surgery|
|Early online date||29 Jul 2022|
|Publication status||Published - 9 Sept 2022|
Bibliographical note© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Funding: William McDevitt is part-funded by a West Midlands Higher Education England Pre-Doctoral Bridging Programme fellowship and the NMAHPs Integrated Clinical Academic Research Unit, Birmingham Health Partners. Nigel Drury is funded by an Intermediate Clinical Research Fellowship from the British Heart Foundation [FS/15/49/31612]. Barnaby Scholefield is funded by a National Institute for Health Research Clinician Scientist Fellowship award [CS-2015-15-016]. The authors received no specific funding for this project. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, Birmingham Health Partners or the British Heart Foundation.
- Paediatric cardiac surgery
- Hypothermic circulatory arrest
- Neurological injury