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Predictors of electrocerebral inactivity with deep hypothermia.

Publication ,  Journal Article
James, ML; Andersen, ND; Swaminathan, M; Phillips-Bute, B; Hanna, JM; Smigla, GR; Barfield, ME; Bhattacharya, SD; Williams, JB; Gaca, JG ...
Published in: J Thorac Cardiovasc Surg
March 2014

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°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°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/m(2)), white race (7 minutes), and starting nasopharyngeal temperature (3 minutes/°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°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.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

March 2014

Volume

147

Issue

3

Start / End Page

1002 / 1007

Location

United States

Related Subject Headings

  • Young Adult
  • Time Factors
  • Thermography
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries
  • Predictive Value of Tests
  • Postoperative Complications
  • Nasopharynx
 

Citation

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MLA
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James, M. L., Andersen, N. D., Swaminathan, M., Phillips-Bute, B., Hanna, J. M., Smigla, G. R., … Hughes, G. C. (2014). Predictors of electrocerebral inactivity with deep hypothermia. J Thorac Cardiovasc Surg, 147(3), 1002–1007. https://doi.org/10.1016/j.jtcvs.2013.03.022
James, Michael L., Nicholas D. Andersen, Madhav Swaminathan, Barbara Phillips-Bute, Jennifer M. Hanna, Gregory R. Smigla, Michael E. Barfield, et al. “Predictors of electrocerebral inactivity with deep hypothermia.J Thorac Cardiovasc Surg 147, no. 3 (March 2014): 1002–7. https://doi.org/10.1016/j.jtcvs.2013.03.022.
James ML, Andersen ND, Swaminathan M, Phillips-Bute B, Hanna JM, Smigla GR, et al. Predictors of electrocerebral inactivity with deep hypothermia. J Thorac Cardiovasc Surg. 2014 Mar;147(3):1002–7.
James, Michael L., et al. “Predictors of electrocerebral inactivity with deep hypothermia.J Thorac Cardiovasc Surg, vol. 147, no. 3, Mar. 2014, pp. 1002–07. Pubmed, doi:10.1016/j.jtcvs.2013.03.022.
James ML, Andersen ND, Swaminathan M, Phillips-Bute B, Hanna JM, Smigla GR, Barfield ME, Bhattacharya SD, Williams JB, Gaca JG, Husain AM, Hughes GC. Predictors of electrocerebral inactivity with deep hypothermia. J Thorac Cardiovasc Surg. 2014 Mar;147(3):1002–1007.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

March 2014

Volume

147

Issue

3

Start / End Page

1002 / 1007

Location

United States

Related Subject Headings

  • Young Adult
  • Time Factors
  • Thermography
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries
  • Predictive Value of Tests
  • Postoperative Complications
  • Nasopharynx