Detection and elimination of potentially pathologic air embolization in cardiac surgery with the use of multi-modal neuromonitoring: a case report
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Abstract
Neurological injuries can occur at the time of cardiac surgery. The results of such complications can be life-altering and altogether fatal. Most commonly, Near-infrared spectroscopy (NIRS), which measures brain oxygenation, is the only neuromonitoring that is performed at the time of cardiac surgery. This is despite publications that multi-modal intra-operative neuromonitoring provides a range of information to the cardiac surgery team, that not only detects an insult, but can provide detailed information to allow intervention that will mitigate the devastating result of such insult. We present this case report to demonstrate how multi-modal neuromonitoring allowed us to detect and eliminate a potentially devastating air embolization. We advocate for the use of multi-modal neuromonitoring in every cardiac case.
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References
2. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996 Dec 19;335(25):1857-63.
3. Gaudino M, Rahouma M, Di Mauro M, Yanagawa B, Abouarab A, Demetres M, Di Franco A, Arisha MJ, Ibrahim DA, Baudo M, Girardi LN, Fremes S. Early Versus Delayed Stroke After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019 Jul 2;8(13).
4. Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A, Sowell MK, Cheppo CD, Corlett KM. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6.
5. Edmonds HL Jr. Protective effect of neuromonitoring during cardiac surgery. Ann N Y Acad Sci. 2005 Aug; 1053:12-9.
6. Zanatta P, Messerotti Benvenuti S, Bosco E, Baldanzi F, Palomba D, Valfrè C. Multimodal brain monitoring reduces major neurologic complications in cardiac surgery. J Cardiothorac Vasc Anesth. 2011 Dec;25(6):1076-85.
7. Edmonds H.L, Monitoring of cerebral Perfusion with Transcranial Doppler Ultrasound Intraoperative Monitoring of Neural Function, handbook of Clinical Neurophysiology, Vol. 8 M.R. Nuwer (Ed.) Elsevier B.V. Chapter 67, 2008; 959-974.
8. Kruis RW, Vlasveld FA, Van Dijk D. The (un)importance of cerebral microemboli. Semin Cardiothorac Vasc Anesth. 2010 Jun;14(2):111-8.
9. Patel N, Minhas JS, Chung EM. Intraoperative Embolization and Cognitive Decline After Cardiac Surgery: A Systematic Review. Semin Cardiothorac Vasc Anesth. 2016 Sep;20(3):225-31.
10. Serraino GF, Murphy GJ. Effects of cerebral near-infrared spectroscopy on the outcome of patients undergoing cardiac surgery: a systematic review of randomised trials. BMJ Open. 2017 Sep 7;7(9).
11. Yeh T, Millan D, Calaritis C, Miller J, Adams D, Sehic A, EEG-based Neuromonitoring Improves Identification Of Neural Threats During Cardiac Surgery, Congenital Heart Surgeons Society, CHSS Meeting, Chicago IL, 2021.
12. Kunst G, Gauge N, Salaunkey K, Spazzapan M, Amoako D, Ferreira N, Green DW, Ballard C. Intraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery-A Randomized Controlled Pilot Trial. J Cardiothorac Vasc Anesth. 2020 May;34(5):1172-1181.
13. Yeh T, Millan D, Calaritis C, Miller J, Adams D, Sehic A, A Coordinated Team Can Extinguish 95% Of Neural Threats Identified By EEG-Based Multimodality Neuromonitoring In Cardiac Surgery. Congenital Heart Surgeons Society, CHSS Meeting, Chicago IL, 2022.
14. Yeh T Jr, Austin EH 3rd, Sehic A, Edmonds HL Jr. Rapid recognition and treatment of cerebral air embolism: the role of neuromonitoring. J Thorac Cardiovasc Surg. 2003 Aug;126(2):589-91.
15. Thudium M, Heinze I, Ellerkmann RK, Hilbert T. Cerebral Function and Perfusion during Cardiopulmonary Bypass: A Plea for a Multimodal Monitoring Approach. Heart Surg Forum. 2018 Jan 31;21(1):E028-E035. doi: 10.1532/hsf.1894. PMID: 29485961.