| Title |
Novel mode of heart and lung machine for real-time identification of cerebral autoregulation impairments during cardiac surgery with cardiopulmonary bypass: prospective observational study |
| Authors |
Kasputyte, Greta ; Putnynaite, Vilma ; Chaleckas, Edvinas ; Bartusis, Laimonas ; Hamarat, Yasin ; Zakelis, Rolandas ; Svagzdiene, Milda ; Kumpaitiene, Birute ; Andrejaitiene, Judita ; Lenkutis, Tadas ; Gelmanas, Arunas ; Sirvinskas, Edmundas ; Petkus, Vytautas ; Ragauskas, Arminas ; Benetis, Rimantas |
| DOI |
10.23736/S0375-9393.25.18890-1 |
| Full Text |
|
| Is Part of |
Minerva anestesiologica.. Turin : Edizioni Minerva Medica. 2025, vol. 91, iss. 10, p. 919-928.. ISSN 0375-9393. eISSN 1827-1596 |
| Keywords [eng] |
Coronary artery bypass ; Cerebrovascular circulation ; Cardiopulmonary bypass ; Postoperative cognitive complications ; Heart-lung machine |
| Abstract [eng] |
BACKGROUND: Postoperative cognitive dysfunction (POCD) occurs in 20% to 80% of patients following cardiac surgical interventions. The incidence of delirium is from 20% to 50%. Impaired cerebral autoregulation (CA) during cardiopulmonary bypass (CPB) contributes to these issues. We investigated a novel method for real-time monitoring of CA during CPB. The study aimed to obtain real-time CA impairment data to demonstrate the timely arterial blood pressure (ABP) management for immediate restoration of intact CA and, potentially, to reduce the incidences of POCD and delirium. METHODS: An observational pilot clinical trial involved 108 elective on-pump surgery patients of whom 78 were included in the final analysis. All patients were evaluated for cognitive function on the 7th to 10th postoperative day. A rectangular blood flow modulation technique was proposed and applied to facilitate real-time detection of CA status impairment by using CA(t) transient response analysis. RESULTS: A single CA impairment event lasting longer than 241 seconds was statistically significantly associated with POCD (P=0.0178), while impairments exceeding 262 seconds were related to delirium (P=0.0315). It was demonstrated that CA impairment events and patient-specific lower and upper limits of CA can be identified with sub-minute delays during cardiac surgery. CONCLUSIONS: The study demonstrated the feasibility of a novel heart and lung machine operation mode with rectangular blood flow modulation. Precise personal ABP(t) management can be performed during CPB to restore patient-specific optimal brain perfusion with sub-minute time resolution and, potentially, to reduce incidences of POCD and delirium. |
| Published |
Turin : Edizioni Minerva Medica |
| Type |
Journal article |
| Language |
English |
| Publication date |
2025 |
| CC license |
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