A Multicenter Pilot Study Assessing Regional Cerebral Oxygen Desaturation Frequency During Cardiopulmonary Bypass and Responsiveness to an Intervention Algorithm

• Type of Material: Article
• Authors: Balachundhar Subramanian, Harvard University; Charles Nyman, Harvard University; Maria Fritock, Mayo Clinic School of Medicine; Rebecca Y. Klinger, Duke University; Roman Sniecinski, Emory University; Philip Roman, University of Maryland; Julie Huffmyer, University of Virginia; Michelle Parish, Johns Hopkins University; Gayane Yenokyan, Johns Hopkins University; Charles W. Hogue, Johns Hopkins University
• Language: English
• Date: 2016-06-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 International Anesthesia Research Society.
• Final Published Version (URL): http://dx.doi.org/10.1213/ANE.0000000000001275
• Title of Journal or Parent Work: Anesthesia and Analgesia
• ISSN: 0003-2999
• Volume: 122
• Issue: 6
• Start Page: 1786
• End Page: 1793
• Grant/Funding Information: Supported, in part, by an unrestricted grant from Covidien, Inc. (Medtronic/Covidien, Boulder, CO), by individual institutional funds, and by National Institutes of Health (NIH) grant R01 94600 to Dr. Hogue.
• Keywords: STROKE; Life Sciences & Biomedicine; MANAGEMENT; NEAR-INFRARED SPECTROSCOPY; Anesthesiology; NEUROLOGIC OUTCOMES; Science & Technology; SURGERY; CARDIAC SURGICAL-PATIENTS; SATURATION
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

BACKGROUND: The purpose of this multicenter pilot study was to: (1) determine the frequency of regional cerebral oxygen saturation (rSco 2) desaturations during cardiac surgery involving cardiopulmonary bypass (CPB); (2) evaluate the accuracy of clinician-identified rSco 2 desaturations compared with those recorded continuously during surgery by the near-infrared spectroscopy (NIRS) monitor; and (3) assess the effectiveness of an intervention algorithm for reversing rSco 2 desaturations. METHODS: Two hundred thirty-five patients undergoing coronary artery bypass graft and/or valvular surgery were enrolled at 8 US centers in this prospective observational study. NIRS (Invos™ 5100C; Covidien) was used to monitor rSco 2 during surgery. The frequency and magnitude of rSco 2 decrements >20% from preanesthesia baseline were documented, and the efficacy of a standard treatment algorithm for correcting rSco 2 was determined. The data from the NIRS monitor were downloaded at the conclusion of surgery and sent to the coordinating center where the number of clinician-identified rSco 2 desaturation events was compared with the number detected by the NIRS monitor. RESULTS: The average rSco 2 obtained at baseline (mean ± SD, 61% ± 11%; 99% confidence interval, 57%-65%) and during CPB (62% ± 14%; 57%-67%) was not different. However, rSco 2 after separation from CPB (56% ± 11%; 53%-60%) was lower than measurements at baseline and during CPB (P < 0.001). During CPB, rSco 2 desaturations occurred in 61% (99% confidence interval, 50%-75%) of patients. The area under the curve for product of magnitude and duration of the rSco 2 was (mean ± SD, 145.2; 384.8% × min). Clinicians identified all patients with an rSco 2 desaturation but identified only 340 (89.5%) of the 380 total desaturation events. Of the 340 clinician-identified rSco 2 desaturation events, 115 resolved with usual clinical care before implementation of the treatment algorithm. For the remaining 225 events, the treatment algorithm resulted in resolution of the rSco 2 desaturation in all but 18 patients. CONCLUSIONS: This multicenter pilot study found that 50% to 75% of patients undergoing cardiac surgery experience one or more rSco 2 desaturations during CPB. Nearly 10% of desaturation events were not identified by clinicians, suggesting that appropriate alarming systems should be adopted to alert clinicians of such events. The intervention algorithm was effective in reversing clinically identified rSco 2 desaturations in the majority of events.