Protecting the Infant Brain During Cardiac Surgery: A Systematic Review

Department of Pediatrics, The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
The Annals of Thoracic Surgery (Impact Factor: 3.85). 10/2012; 94(4):1365. DOI: 10.1016/j.athoracsur.2012.05.135


Prevention of brain injury during congenital heart sur-gery has focused on intraoperative and perioperative neuroprotection and neuromonitoring. Many strategies have been adopted as "standard of care." However, the strength of evidence for these practices and the relation-ship to long-term outcomes are unknown. We performed a systematic review (January 1, 1990 to July 30, 2010) of neuromonitoring and neuroprotection strategies during cardiopulmonary bypass (CPB) in in-fants of age 1 year or less. Papers were graded individu-ally and as thematic groups, assigning evidence-based medicine and American College of Cardiology/American Heart Association (ACC/AHA) level of evidence grades. Consensus scores were determined by adjudication. Literature search identified 527 manuscripts; 162 met inclusion criteria. Study designs were prospective obser-vational cohort (53.7%), case-control (21.6%), randomized clinical trial (13%), and retrospective observational co-hort (9.9%). Median sample size was 43 (range 3 to 2,481).

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