602 Brain Monitoring of Newborns Undergoing Cardiac Surgery with Cardiopulmonary Bypass (CBP)

Abstract

Aim: To study cerebral electrical activity and local regional oximetry during cardiopulmonary by-pass (CPB) and determine the periods of time in which the brain is at its most vulnerability.

Setting: Neonatal intensive care unit of a tertiary university-affiliated children's hospital.

Methods: Prospective observational study of newborns with congenital heart disease needing surgical therapy on CBP. Regional cerebral oxymetry (CrSO2) with near-infrared spectroscopy (NIRS, INVOS) and amplitude integrated electroencephalography (aEEG, CFM Olympic) were continuously monitored.

Results: 23 infants were studied. 19/23 underwent cardiac surgery on CPB with deep hypothermic circulatory arrest (DHCA), 2 had selective cerebral perfusion (SCP), 4/23 did not need circulatory arrest. 70.6% presented critical electric activity during circulatory arrest (aEEG) and a rapid fall in cerebral oxymetry (CrSO2 < 40%) during CPB-DHCA. The electrical activity ceased when reentering cardiopulmonary bypass. In cases of CPB with SCP there was no critical electrical activity in the aEEG, nonetheless these patients had critical values of CrSO2 in the postoperative period.

Electrical seizures occurred in 19/23 patients (82.6%). During anesthetic induction 2 patients presented seizures (8.7%), 12 (52.2%) during DHCA, 8 (34.8%) during modified ultrafiltration (MUF), 7 (30.4%) during re-warming and 4 (17.4%) during the postoperative period. Only 4 patients (17.4%) didn't have critical electrical activity at any time.

Conclusions: Brain activity monitoring with aEEG allows us to identify seizures during CPB, which suggests an inadequate neuro-protection mostly during circulatory arrest.

The combined use of aEEG and INVOS allows a rapid detection of high-risk situations for neurological injury and low cardiac output.

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