CEREBRAL AUTOREGULATION MONITORING TO REDUCE POSTOPERATIVE NEUROLOGICAL COMPLICATIONS FROM CARDIAC SURGERY: ONGOING STUDY

Abstract

<h3>Introduction and objective</h3> Disturbances of various duration of cerebral autoregulation (CA) have been documented during cardiac surgery and are associated with poor neurological outcomes. Meanwhile, patient-specific thresholds for CA are unknown. The aim of our study is to determine the influence of CA monitoring on the incidence of postoperative neurological complications in patients undergoing cardiac surgery. <h3>Design and method</h3> A prospective pilot observational study (as a part of ongoing study, funded by Lithuanian Central Project Management Agency (CPVA) grant No 01.2.2. - CPVA - K - 703 - 03 - 0025 and by EU Structural Funds) was conducted in 2021–2022. The study enrolled 30 patients undergoing elective CABG surgery with cardiopulmonary bypass (CBP). All patients were assessed for cognitive function 1 day before surgery and on the 7–10th postoperative day using MMSE-2, ACE-III tests. The CA was monitored during surgery using transcranial Doppler ultrasonography (TCD). Postoperatively delayed recovery of cognitive functions (DNR) and postoperative delirium were recorded. <h3>Results</h3> 10 patients were excluded from data analysis due to postoperative delirium, refusal to perform postoperative tests or lack of ultrasound transmission window for TCD. The average age of the rest 20 patients was 66.25± 6.87 years, most of them were men (85 % n=17). The CA monitoring data of analysed patients are presented in Table 1. <h3>Conclusions</h3> Preliminary data confirmed that temporary CA impairment occurs in all patients undergoing elective on-pump CABG surgery. TCD commonly used in clinical practice for CA evaluation has several limitations: it is highly operator dependent, and some patients have no inadequate ultrasound transmission windows. The study is ongoing, and we continue to collect the patient data, to find a better method of CA monitoring and statistically significant conclusions.