Issue |
J Extra Corpor Technol
Volume 42, Number 1, March 2010
|
|
---|---|---|
Page(s) | 40 - 44 | |
DOI | https://doi.org/10.1051/ject/201042040 | |
Published online | 15 March 2010 |
Abstract
Microemboli from Cardiopulmonary Bypass are Associated with a Serum Marker of Brain Injury
* Cardiac Surgery, Maine Medical Center, Portland, Maine
† Department of Anesthesia, Maine Medical Center, Portland, Maine
∥ Department of Surgery, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
§ Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
‡ Department of Anesthesiology, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
# Department of Medicine, Dartmouth Medical School, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
¶ Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
Address correspondence to: Donald S. Likosky, 503 Rubin Bldg, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. E-mail: donald.likosky@dartmouth.edu
Received:
8
July
2009
Accepted:
21
January
2010
An increasing number of reports surrounding neurologic injury in the setting of cardiac surgery has focused on utilizing biomarkers as intermediate outcomes. Previous research has associated cerebral microemboli and neurobehavioral deficits with biomarkers. A leading source of cerebral microemboli is the cardiopulmonary bypass (CPB) circuit. This present study seeks to identify a relationship between microemboli leaving the CPB circuit and a biomarker of neurologic injury. We enrolled 71 patients undergoing coronary artery bypass grafting at a single institution from October 14, 2004 through December 5, 2007. Microemboli were monitored using Power-M-Mode Doppler in the inflow and outflow of the CPB circuit. Blood was sampled before and within 48 hours after surgery. Neurologic injury was measured using S100β (microg/L). Significant differences in post-operative S100β relative to microemboli leaving the circuit were tested with analysis of variance and Kruskal-Wallis. Most patients had increased serum levels of S100β (mean .25 microg/L, median .15 microg/L) following surgery. Terciles of microemboli measured in the outflow (indexed to the duration of time spent on CPB) were associated with elevated levels of S100β (p = .03). Microemboli leaving the CPB circuit were associated with increases in postoperative S100β levels. Efforts aimed at reducing microembolic load leaving the CPB circuit should be adopted to reduce brain injury.
Key words: embolism / cardiopulmonary bypass / complications / coronary artery bypass grafting surgery
© 2010 AMSECT
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