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Impaired cerebral autoregulation and elevation in plasma glial fibrillary acidic protein level during cardiopulmonary bypass surgery for CHD

Published online by Cambridge University Press:  24 August 2017

Ronald B. Easley ,
Bradley S. Marino ,
Jacky Jennings ,
Amy E. Cassedy ,
Kathleen K. Kibler ,
Ken M. Brady ,
Dean B. Andropoulos ,
Marissa Brunetti ,
Charles W. Hogue  and
Eugenie S. Heitmiller
...Show all authors
Ronald B. Easley*
Affiliation:
Texas Children’s Hospital, Houston, Texas, United Sates of America
Bradley S. Marino
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois, United Sates of America Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United Sates of America
Jacky Jennings
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
Amy E. Cassedy
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois, United Sates of America
Kathleen K. Kibler
Affiliation:
Texas Children’s Hospital, Houston, Texas, United Sates of America
Ken M. Brady
Affiliation:
Texas Children’s Hospital, Houston, Texas, United Sates of America
Dean B. Andropoulos
Affiliation:
Texas Children’s Hospital, Houston, Texas, United Sates of America
Marissa Brunetti
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
Charles W. Hogue
Affiliation:
Northwestern University Feinberg School of Medicine, Chicago, Illinois, United Sates of America Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
Eugenie S. Heitmiller
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
Jennifer K. Lee
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
James Spaeth
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United Sates of America
Allen D. Everett
Affiliation:
Johns Hopkins Hospital, Baltimore, Maryland, United Sates of America
*
Correspondence to: R. B. Easley, MD, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin WT17-417, Houston, TX 77030, United States of America. Tel: +832 826 5831; Fax: 832 825 5804; E-mail: rbeasley@texaschildrens.org
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Abstract

Background

Cerebrovascular reactivity monitoring has been used to identify the lower limit of pressure autoregulation in adult patients with brain injury. We hypothesise that impaired cerebrovascular reactivity and time spent below the lower limit of autoregulation during cardiopulmonary bypass will result in hypoperfusion injuries to the brain detectable by elevation in serum glial fibrillary acidic protein level.

Methods

We designed a multicentre observational pilot study combining concurrent cerebrovascular reactivity and biomarker monitoring during cardiopulmonary bypass. All children undergoing bypass for CHD were eligible. Autoregulation was monitored with the haemoglobin volume index, a moving correlation coefficient between the mean arterial blood pressure and the near-infrared spectroscopy-based trend of cerebral blood volume. Both haemoglobin volume index and glial fibrillary acidic protein data were analysed by phases of bypass. Each patient’s autoregulation curve was analysed to identify the lower limit of autoregulation and optimal arterial blood pressure.

Results

A total of 57 children had autoregulation and biomarker data for all phases of bypass. The mean baseline haemoglobin volume index was 0.084. Haemoglobin volume index increased with lowering of pressure with 82% demonstrating a lower limit of autoregulation (41±9 mmHg), whereas 100% demonstrated optimal blood pressure (48±11 mmHg). There was a significant association between an individual’s peak autoregulation and biomarker values (p=0.01).

Conclusions

Individual, dynamic non-invasive cerebrovascular reactivity monitoring demonstrated transient periods of impairment related to possible silent brain injury. The association between an impaired autoregulation burden and elevation in the serum brain biomarker may identify brain perfusion risk that could result in injury.

Keywords

Autoregulationcerebrovascular reactivitycardiopulmonary bypassCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 55 - 65
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Copyright
© Cambridge University Press 2017 

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Footnotes

*

Ronald B. Easley and Bradley S. Marino are co-first authors.

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