Optical monitoring of cerebral perfusion and metabolism in adults during cardiac surgery with cardiopulmonary bypass

• DOI: 10.1364/boe.404101
• Publication Date: 2020-09-03T13:30:06Z
• Authors: Ajay Rajaram; Daniel Milej; Marianne Suwalski; Lawrence C. M. Yip; Linrui R. Guo; Michael W. A. Chu; Jason Chui; Mamadou Diop; John M. Murkin; Keith St. Lawrence
• Keywords: Cerebral Hypoperfusion

During cardiac surgery with cardiopulmonary bypass (CPB), adequate maintenance of cerebral blood flow (CBF) is vital in preventing postoperative neurological injury - i.e. stroke, delirium, cognitive impairment. Reductions CBF large enough to impact energy metabolism can lead tissue damage and subsequent brain injury. Current methods for neuromonitoring during are limited. This study presents the clinical translation a hybrid optical neuromonitor continuous intraoperative monitoring perfusion ten patients undergoing non-emergent non-pulsatile CPB. The system combines broadband near-infrared spectroscopy (B-NIRS) measure changes oxidation state cytochrome c oxidase (oxCCO) direct marker cellular diffuse correlation (DCS) provide an index (CBFi). As heart was arrested CPB-pump started, increases CBFi (88.5 ± 125.7%) significant decreases oxCCO (-0.5 0.2 µM) were observed; no noted transitions off Fifteen hypoperfusion events, defined as sustained reductions rate, identified across all resulted when mean arterial pressure dropped 30 mmHg or below. maximum reduction preceded corresponding metabolic by 18.2 15.0 s. Optical provides safe non-invasive approach assessing has potential guiding patient management prevent adverse outcomes.