Cerebral Desaturation during Cardiac Surgery

Cerebral desaturation results from an imbalance between cerebral oxygen supply and demand resulting from either limited cerebral blood supply, inadequate oxygen content, or unmet cerebral metabolic demand.

Up to 37% of patients experience cerebral desaturation during cardiac surgery([FOOTNOTE=Schoen J, Husemann L, Tiemeyer C, et al. Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. British journal of anaesthesia. 2011;106(6):840-850],[ANCHOR=],[LINK=])

Three quarters of patients experience cerebral desaturation during high-risk cardiac surgery([FOOTNOTE=Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266.],[ANCHOR=],[LINK=])

A greater degree of intraoperative cerebral desaturation is associated with:

• Increased incidence of postoperative cognitive dysfunction([FOOTNOTE=de Tournay-Jette E, Dupuis G, Bherer L, Deschamps A, Cartier R, Denault A. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery. Journal of cardiothoracic and vascular anesthesia. 2011;25(1):95-104.],[ANCHOR=],[LINK=])
• Increased incidence of postoperative delirium([FOOTNOTE=Schoen J, Meyerrose J, Paarmann H, Heringlake M, Hueppe M, Berger KU. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care. 2011;15(5):R218],[ANCHOR=],[LINK=])
• Increased hospital length of stay in high risk patients([FOOTNOTE=Schön J, Serien V, Heinze H, et al. Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery. Appl Cardiopulm Pathophysiol. 2009;13:201-207.],[ANCHOR=],[LINK=])
• Increased ICU length of stay in high risk patients⁵

Cerebral desaturation is a common occurrence during cardiac surgery that may adversely affect clinical outcome([FOOTNOTE=Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia and analgesia. 2007;104(1):51-58.],[ANCHOR=],[LINK=]) and the cost of care.([FOOTNOTE=Goldman SM, Sutter FP, Wertan MA, Ferdinand FD, Trace CL, Samuels LE. Outcome improvement and cost reduction in an increasingly morbid cardiac surgery population. Semin Cardiothorac Vasc Anesth. 2006;10(2):171-175.],[ANCHOR=],[LINK=])

The INVOS cerebral/somatic oximeter provides clinicians with a trend of intraoperative regional cerebral oxygenation. The data obtained from rSO2 monitoring may be used to reverse decreasing cerebral perfusion and avert prolonged cerebral desaturation.²

INVOS-guided detection and correction of cerebral desaturation may assist clinicians in improving patient outcomes.⁶

Compared to controls, INVOS-guided reduction of cerebral desaturation:

• Reduced mean cerebral desaturation time by 39%([FOOTNOTE=Harilall Y, Adam JK, Biccard BM, Reddi A. The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart, lung & circulation. 2014;23(1):68-74.],[ANCHOR=],[LINK=])
• Reduced permanent stroke by 51.74%([FOOTNOTE=Goldman S, Sutter F, Ferdinand F, Trace C. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. The heart surgery forum. 2004;7(5):E376-381.],[ANCHOR=],[LINK=])
• Reduced the incidence of prolonged postoperative mechanical ventilation by 35.85%⁹
• Reduced ICU length of stay by 30.74%⁶
• Reduced post-operative cognitive decline by 46.15%([FOOTNOTE=Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2015 Mar;47(3):447-54.],[ANCHOR=],[LINK=])
• Reduced major organ morbidity and mortality by 72.72%⁶