- 作者：Michael L. James ; Nicholas D. Andersen ; Madhav Swaminathan ; Barbara Phillips-Bute ; Jennifer M. Hanna ; Gregory R. Smigla ; Michael E. Barfield ; Syamal D. Bhattacharya ; Judson B. Williams ; Jeffrey G. Gaca ; Aatif M. Husain ; G. Chad Hughes
- 关键词：19 ; 26.1
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：March, 2014
- 年：2014
- 卷：147
- 期：3
- 页码：1002-1007
- 全文大小：248 K
Objective
Cooling to electrocerebral inactivity (ECI) by electroencephalography (EEG) remains the gold standard to maximize cerebral and systemic organ protection during deep hypothermic circulatory arrest (DHCA). We sought to determine predictors of ECI to help guide cooling protocols when EEG monitoring is unavailable.Methods
Between July 2005 and July 2011, 396 patients underwent thoracic aortic operation with DHCA; EEG monitoring was used in 325 (82%) of these patients to guide the cooling strategy, and constituted the study cohort. Electroencephalographic monitoring was used for all elective cases and, when available, for nonelective cases. Multivariable linear regression was used to assess predictors of the nasopharyngeal temperature and cooling time required to achieve ECI.
Results
Cooling to a nasopharyngeal temperature of 12.7掳C or for a duration of 97 minutes was required to achieve ECI in >95% of patients. Only 7% and 11% of patients achieved ECI by 18掳C or 50 minutes of cooling, respectively. No independent predictors of nasopharyngeal temperature at ECI were identified. Independent predictors of cooling time included body surface area (18 minutes/m2), white race (7 minutes), and starting nasopharyngeal temperature (3 minutes/掳C). Low complication rates were observed (ischemic stroke, 1.5%; permanent paraparesis/paraplegia, 1.5%; new-onset dialysis, 2.2%; and 30-day/in-hospital mortality, 4.3%).
Conclusions
Cooling to a nasopharyngeal temperature of 12.7掳C or for a duration of 97 minutes achieved ECI in >95% of patients in our study population. However, patient-specific factors were poorly predictive of the temperature or cooling time required to achieve ECI, necessitating EEG monitoring for precise ECI detection.