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Eur J Cardiothorac Surg 2004;25:401-406
© 2004 Elsevier Science NL

Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function

Departments of Anesthesiology and Biomathematical Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA

Received 4 June 2003; received in revised form 23 October 2003; accepted 27 November 2003.

^* Corresponding author. Address: Department of Anesthesiology, Box 1010, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA. Tel.: +1-212-241-7467; fax: +1-212-241-1847
e-mail: david.reich{at}msnyuhealth.org

Objectives: Deep hypothermic circulatory arrest (DHCA) is commonly used during thoracic aortic surgery, and is initiated only after a sufficient degree of cerebral hypothermia is induced. The criteria for initiating DHCA vary among institutions: most centers use temperature criteria, some use electroencephalography, and a minority use jugular bulb oxyhemoglobin saturation SjO₂ criteria. The purpose of this study was to determine whether the use of SjO₂ monitoring to guide the onset of DHCA was associated with better post-operative neuropsychological outcome. Methods: Sixty-one thoracic aortic surgical patients underwent both pre- and post-operative neuropsychological testing. Patients were divided into three groups: (1) those with SjO₂95% at DHCA onset; (2) those with SjO₂<95% at DHCA onset; and (3) those without SjO₂ monitoring. Results: There were no statistically significant differences in the incidence of post-operative decline in neuropsychological function among the three groups of patients. Patients in whom SjO₂ data were used to guide onset of DHCA had lower esophageal and bladder temperatures at that time compared with patients without SjO₂ monitoring. Conclusions: Monitoring of SjO₂ had no apparent effect upon post-operative neuropsychological outcome, and there were no trends in our small patient cohort suggesting differences that our study was not adequately powered to detect. Use of SjO₂ monitoring was associated with more profound hypothermia prior to DHCA due to more prolonged cooling in attempts to bring the SjO₂ above the 95% threshold. Using our institutional cooling protocol, SjO₂ monitoring does not appear to increase neuroprotection in patients undergoing DHCA for thoracic aortic repairs.

Key Words: Aortic aneurysm • Thoracic • Thoracic surgery • Neuropsychology • Outcome study • Hypothermic circulatory arrest • Jugular bulb oxyhemoglobin saturation

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Editorial comment: Post-operative neuropsychological function unaffected by SjO₂ monitoring in DHCA

Teruhisa Kazui
Eur. J. Cardiothorac. Surg. 2004 25: 406-408. [Extract] [Full Text] [PDF]

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