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36. Trial application of a new modality to reduce neurocognitive dysfunction following cardiopulmonary bypass - Results of a prospective randomised double-blind study.
Joseph Alex, Gerard Laden, Kenneth Flowers, Alex RJ Cale, Sean Bennett, Levent Guvendik, Peter T Mccollum, Steven C Griffin; Hull, United Kingdom
Objective:
In animal models, pre-treatment with hyperbaric oxygen induces ischemic tolerance in the central nervous system. We evaluate the effect of this modality on neurocognitive dysfunction following cardiopulmonary bypass.
Methods:
64 patients prospectively randomised to either Group-A (n-31) 1.5 atmospheres-absolute (ATA) air or Group-B (n-33) 2.4 ATA hyperbaric oxygen. The patients, surgeons and neuropsyhcologist were blinded to the study groups. Pre-treatment regime was 60 minutes at depth, 24hr, 12hrs and 4 hrs pre-operation.
Age, gender, BMI, diabetes, hypertension, smoking, coronary disease severity, LV function, Parsonnet score, Euroscore, bypass time, cross-clamp time, number of grafts, verbal and non-verbal IQ, and hospital anxiety-depression scores were comparable. CCS angina, NYHA dyspnoea, and previous MI were significantly higher in group-B.
Neurologic examination and a neuropsychometric battery consisting of Rey auditory-verbal learning test, trail-making A and B, grooved peg-board, adult memory and information processing table-A, and digit-span forwards and backwards were performed 48hrs pre-operation and 4 months post-operation. Neurocognitive dysfunction was defined as > 1 standard-deviation decline in scores in > 20% tests at 4 months.
Results:
Neurocognitive dysfunction was significantly higher (p-0.05) in group-A (55.2%) compared to group-B (30%).
There was no significant difference in ventilation time, ICU stay and length of stay, postoperative inotrope usage, blood transfusion, cardiac arrhythmia, renal dysfunction, gastrointestinal complications, sepsis, stroke or multi-organ dysfunction.
Conclusions:
In our study pre-treatment with hyperbaric oxygen reduced neurocognitive dysfunction after cardiopulmonary bypass. Further multi-center trials are needed to evaluate this modality. Perhaps selective application in patients at high risk of neurocognitive decline could be an option.
Group comparison
|
Group-A |
Group-B |
p-value |
| Age |
65.9 +/- 1.7 yrs |
66.2 +/- 1.5yrs |
0.9 |
| Male : Female |
5:1 |
7:1 |
0.7 |
| Poor LV function |
3.2% |
3.1% |
0.9 |
| History of CVA / TIA |
0 |
0 |
|
| Parsonnet score |
6.5 +/- 1.2 |
7.2 +/- 1 |
0.6 |
| Bypass time |
50.1 +/- 4.3 min |
52.1 +/- 3 min |
0.7 |
| Ischemia time |
23.5 +/- 1.5 |
24.8 +/- 1.4 |
0.5 |
Post-operative
Confusion
TIA |
3.2%
3.2% |
0
0 |
0.2 |
| Neurocognitive dysfunction |
55.2% |
30% |
0.05 |
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