The Predictive Value of Normothermic Cardiopulmonary Bypass Protocol for Early Neurological Complications

A Dual-Center Study in Benghazi

Abstract

The early neurological complications (ENCs), including stroke, seizure, hemiparesis, and delirium, represent a major cause of morbidity in patients who undergo cardiac surgeries for congenital heart disease (CHD), as the immaturity of the central nervous system (CNS) in infants and small children increases the risk of brain insult during cardiac surgeries. Intraoperative risk factors of neurological complications include cerebral air embolism, longer duration of cardiopulmonary bypass (CPB) time, degree of hypothermia, and the strategy of brain neuroprotection to control cerebral perfusion to reduce these risks. This study aims to evaluate the incidence of ENCs and compare outcomes of different hypothermic protocols utilized by three surgical teams. Methods: We conducted a retrospective review of 380 patients undergoing cardiac surgery by three surgical teams, utilizing different hypothermic protocols. Data were analyzed to determine the ENC risks, including age, cardiac complexity, bypass time, and intraoperative temperature. The frequency of (ENCs) was 3.4%. Variation was observed between the surgical teams (p = 0.036). The normothermic protocol team had the highest rate of ENCs (7.7 %), while the other teams had 2.2 % and 1.9%. The normothermic protocol revealed an increased risk of (ENCs) by 2.4 times compared to other teams, which highlights the importance of neuroprotection of hypothermia control during cardiac surgery in centers with limited continuous neurological monitoring.