Abstract 16238: Risk Factors for Early Neurological Injury in Infants Requiring Deep Hypothermic Circulatory Arrest and/or Selective Cerebral Perfusion
Introduction: Some studies associate deep hypothermic circulatory arrest (DHCA) and selective cerebral perfusion (SCP) with neurological injury. For DHCA the effect seems to be duration-dependent, but this dependence has not been investigated for SCP or a combination of SCP+DHCA.
Objective: Assess early neurologic injury (NI) in infants receiving varying durations of SCP and DHCA and identify factors contributing to NI.
Methods: We retrospectively reviewed 118 consecutive pediatric cardiac operations using DHCA and/or SCP at our institution. We collected values for 37 demographic and perioperative variables, including all perioperative events potentially adverse to brain oxygen delivery. We defined NI by presence of any standardized significant imaging, EEG or exam finding, as judged by a neurologist, from index operation to 2 months after hospital discharge. As most patients underwent a combination of DHCA and SCP (predominantly SCP), we could not separate their effects and thus used the sum of their durations (DHCA+SCP) as a covariate. After screening with non-parametric univariable tests (p<0.1), we determined odds ratios for covariates significantly associated with NI using multivariable logistic regression for the entire cohort, the Norwood group (n=62) and non-Norwood group (n=56, 52 with two ventricles).
Results: Median age was 6 days. Mortality was 5.9% (6.5% for Norwood group). Mean DHCA and SCP durations were 21.7 ± 25.9 and 54.7 ± 37.4 min, respectively. Median (range) of DHCA+SCP was 74.5(20,185) min. NI occurred in 36.4% of patients (40.3% for Norwood group). Covariates significantly and independently associated with NI are shown in Table 1. DHCA+SCP was not significantly associated with NI.
Conclusions: NI, as defined in this study, is associated with several pre and postoperative factors and not with DHCA+SCP in any of the three groups analyzed. Adverse events, many of which may be preventable, are particularly strongly associated with NI.
- © 2013 by American Heart Association, Inc.