Objective
Cardiac surgery for repair of congenital heart defects poses unique hazards to the
developing brain. Deep hypothermic circulatory arrest (DHCA) is a simple and effective
method for facilitating a bloodless surgical field during congenital heart defect
repair. There are, however, some concerns that prolonged DHCA increases the risk of
nervous system injury. The electroencephalogram (EEG) is used in adult and, to a lesser
extent, pediatric cardiac procedures as a neuromonitoring method. The present study
was performed to assess outcomes following DHCA with EEG monitoring in the pediatric
population.
Design
In this systematic review and meta-analysis, the PubMed, Cochrane Central Register
of Controlled Trials, Scopus, Institute of Science Index, and Embase databases were
searched from inception for relevant articles. A fixed- or random-effects model, as
appropriate, was used.
Setting
Surgical setting.
Participants
Pediatric population (≤18 y old).
Interventions
DHCA (18°C) with EEG monitoring.
Measurements and Main Results
Nineteen articles with 1,267 pediatric patients ≤18 years were included. The event
rate of clinical and EEG seizures among patients who underwent DHCA was 12.9% and
14.9%, respectively. Mortality was found to have a 6.3% prevalence. A longer duration
of DHCA was associated with a higher risk of EEG seizure and neurologic abnormalities.
In addition, seizures were associated with increased neurologic abnormalities and
neurodevelopmental delay.
Conclusions
EEG and neurologic abnormalities were common after DHCA. A longer duration of DHCA
was found to lead to more EEG seizure and neurologic abnormalities. Moreover, EEG
seizures were more common than clinical seizures. Seizures were found to be associated
with increased neurologic abnormalities and neurodevelopmental delay.
Key Words
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Article info
Publication history
Published online: January 29, 2021
Footnotes
Authors’ Contributions AAAMMA: this author helped in developing the idea, designing the study, writing the protocol, searching the databases, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MGK: this author helped in designing the study, writing the protocol, searching the databases, screening, data extraction, writing, and reviewing the manuscript and approving the final version. EMF: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. ME: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. AF: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. HMY: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MHB: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MA: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. AS: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. AMK: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MFE: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MW: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. AAN: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. HME: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. HZA: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MA: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. HM: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MY: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. AP: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. ME: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version. MKH: this author helped in writing the protocol, screening, data extraction, writing, and reviewing the manuscript and approving the final version.
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- Cutting the Gordian Knot That Ties Intraoperative Conditions to Long-term Neurodevelopmental Outcomes in Children Undergoing Congenital Heart SurgeryJournal of Cardiothoracic and Vascular AnesthesiaVol. 35Issue 10
- PreviewSUBSTANTIAL PROGRESS has been made during the more than 80-year history of pediatric cardiac surgery. With improvements in surgical technique and patient survival, the focus has shifted to alleviating morbidity in young children requiring repair of complex congenital heart disease. Abnormal brain structural and functional outcomes are not infrequently observed in this vulnerable patient population; however, challenges remain to identify when they occur and how they relate to neurodevelopmental abnormalities.
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