Electroencephalographic Response to Deep Hypothermic Circulatory Arrest in Neonatal Swine and Humans.

Autor:	Mavroudis CD; Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: constantine.mavroudis@uphs.upenn.edu., Mensah-Brown KG; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Ko TS; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Boorady TW; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Massey SL; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Abend NS; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Nicolson SC; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Morgan RW; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Mascio CE; Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Gaynor JW; Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Kilbaugh TJ; Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Licht DJ; Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2018 Dec; Vol. 106 (6), pp. 1841-1846. Date of Electronic Publication: 2018 Jul 30.
DOI:	10.1016/j.athoracsur.2018.06.036
Abstrakt:	Background: Piglets are used to study neurologic effects of deep hypothermic circulatory arrest (DHCA), but no studies have compared human and swine electroencephalogram (EEG) responses to DHCA. The importance of isoelectricity before circulatory arrest is not fully known in neonates. We compared the EEG response to DHCA in human neonates and piglets. Methods: We recorded 2 channel, left and right centroparietal, subdermal EEG in 10 neonatal patients undergoing operations involving DHCA and 10 neonatal piglets that were placed on cardiopulmonary bypass and underwent a simulated procedure using DHCA. EEG waveforms were analyzed for the presence and extent of burst suppression and isoelectricity by automated moving window analysis. The patients were monitored with 16-channel array EEG for 48 hours postoperatively and underwent postoperative brain magnetic resonance imaging. Results: After induction of anesthesia, humans and piglets both displayed slowing or brief suppression, then mild burst suppression, and then severe burst suppression during cooling. All piglets subsequently achieved isoelectricity at 22.4° ± 6.9°C, whereas only 1 human did at 20.2°C. Piglets and humans emerged from severe, mild, and then brief suppression patterns during rewarming. Among the patients, there were no seizures during postoperative monitoring and 1 instance of increased white matter injury on postoperative magnetic resonance imaging. Conclusions: Our data suggest that current cooling strategies may not be sufficient to eliminate all EEG activity before circulatory arrest in humans but are sufficient in swine. This important difference between the swine and human response to DHCA should be considered when using this model. (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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