Therapeutic Effect of Perioperative Mild Hypothermia on Postoperative Neurological Outcomes in Patients with Acute Stanford Type A Aortic Dissection
DOI:
https://doi.org/10.1532/hsf.3141Keywords:
mild hypothermia, Stanford type A aortic dissection, Neurological dysfunctionAbstract
Background: Postoperative patients of acute Stanford type A aortic dissection (AAAD) often experience complications consisting of nervous system injury. Mild hypothermia therapy has been proven to provide the therapeutic effect of cerebral protection. We aimed to investigate the therapeutic effects of perioperative mild hypothermia on postoperative neurological outcomes in patients with AAAD.
Methods: A prospective randomized controlled study was conducted on adult patients undergoing aortic dissection surgery between February 2017 and December 2017. Patients in the treatment group underwent mild hypothermia (34° to 35°C) immediately after surgery, and in the conventional therapy group, patients were rewarmed to normal body temperature (36° to 37°C). Postoperative time to regain consciousness, postoperative serum neuron-specific enolase (NSE) and S-100β levels, cerebral tissue oxygen saturation, presence of delirium or permanent neurological dysfunction, intensive care unit (ICU) and hospital stay duration, and 28-day mortality were compared.
Results: We enrolled 55 patients who underwent AAAD surgery and were randomly allocated into to 2 groups, 27 patients in the treatment group and 28 patients in the conventional therapy group. Compared with the conventional therapy group, postoperative time to regain consciousness was much shorter for patients in the mild hypothermia group (12.65 hours, interquartile range [IQR] 8.28 to 23.82, versus 25.80 hours, IQR 14.00 to 59.80; P = .02), and the rate of regaining consciousness in 24 hours after surgery was much higher (74.07% versus 46.42%; P = .037). At the same time, the ICU stay of patients in the mild hypothermia therapy group was significantly shorter than that in the conventional therapy group (5.53 ± 3.13 versus 9.35 ± 8.76 days; P = .038). Cerebral tissue oxygen saturation, incidence of delirium or permanent neurological dysfunction, duration of hospital stay, and 28-day mortality showed no statistical difference. Postoperative serum NSE and S-100β levels increased compared with preoperative baseline values in both groups
(P < .05), and the serum NSE levels of patients in the mild hypothermia therapy was significantly lower than the conventional therapy group 1 hour (P = .049) and 6 hours (P = .04) after surgery. There was no difference in the chest drainage volume or shivering between the 2 groups 24 hours after surgery.
Conclusions: Perioperative mild hypothermia therapy is able to significantly reduce brain cell injury and shorten the postoperative time to regain consciousness, thus improving the neurological prognosis of patients with AAAD.
References
Ali MS, Harmer M, Vaughan R. 2000. Serum S100B protein as a marker of cerebral damage during cardiac surgery. Br JAnaesth 85:287-298.
Amir G, Ramamoorthy C, Riemer RK, et al. 2005. Neonatal brain protection and deep hypothermic circulatory arrest: Pathophysiology of ischemic neuronal injury and protective strategies. Ann Thorac Surg 80:1955-1964.
Berko M, Stefan S, Matthias R, et al. 2016. Serum S100B protein is specifically related to white matter changes in schizophrenia. Front Cell Neurosci 10:33.
Blomquist S, Johnsson P, Luhrs-C, et al. 2011. The appearance of S-100 protein in aerum during and immediately after cardiopulmonary bypass surgery: A possible marker for cerebral injury. Cardiothorac Vasc Anesth 11:699-703.
Bonacchi M, Prifti E, Maiani M, et al. 2006. Does off-pump coronary revascularization reduce the release of the cerebral markers, S-100β and NSE? Heart Lung Circ 15:314-319.
Chabok SY, Moghadam AD, Saneei Z, et al. 2012. Neuron-specific enolase and S100BB as outcome predictors in severe diffuse axonal injury. J Trauma Acute Care Surg 72:1654-1657.
Dix LM, Van Bel F, Lemmers PM. 2017. Monitoring cerebral oxygenation in neonates: An update. Front Pediatr 5:46.
Donato R. 1999. Functional roles of S100 proteins, calcium-binding proteins of the EF-hand type. Biochim Biophys Acta 1450:191-231.
Emmert A, Gries G, Wand S, et al. 2018. Association between perioperative hypothermia and patient outcomes after thoracic surgery: A single center retrospective analysis. Medicine 97:e0528.
Grigore AM, Grocott HP, Mathew JP, et al. 2002. The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analges 94:4-10.
Grigore AM, Murray CF, Ramakrishna H, et al. 2009. A core review of temperature regimens and neuroprotection during cardiopulmonary bypass: Does rewarming rate matter ? Anesth Analges
:1741-1751.
Hori D, Everett AD, Lee JK, et al. 2015. Rewarming rate during cardiopulmonary bypass is associated with release of glial fibrillary acidic protein. Ann Thorac Surg 100:1353-1358.
Meric E, Gunduz A, Turedi S, et al. 2010. The prognostic value of neuron-specific enolase in head trauma patients. J Emerg Med 38:297-301.
Milleit B, Smesny S, Rothermundt M, et al. 2016. Serum S100B protein is specifically related to white matter changes in schizophrenia. Front Cell Neurosci 10:33.
Nienaber CA, Clough RE. 2015. Management of acute aortic dissection. Lancet 385:800-811.
Persson L, Haardemark H-G, Gustafsson J. 1987. S-100 protein and neuron-specific enolase in cerebrospinal fluid and serum: Markers of cell damage in human central nervous system. Stroke 18:1-8.
Reiber H. 2003. Proteins in cerebrospinal fluid and blood: Barriers, CSF flow rate and source-related dynamics. Restor Neurol Neurosci 21:1-19.
Schaarschmidt H, Prange H, Reiber H. 1994. Neuron-specific enolase concentrations. Stroke 25:558-565.
Schafer BW, Heizmann CW. 1996. The S100 family of EF-hand calcium-binding proteins: Functions and pathology. Trends Biochem Sci 21:134-140.
Stammet P, Collignon O, Hassager C, et al. 2015. Neuron-specific enolase as a predictor of death or poor neurological outcome after out-of-hospital cardiac arrest and targeted temperature management at 33°C and 36°C. J Am Coll Cardiol 65:2104-2114.
Stein LH, Rubinfeld G, Balsam LB, et al. 2017. Too cold to clot? Does intraoperative hypothermia contribute to bleeding after aortic surgery? Aorta 5:106-116.
Yokobori S, Hosein K, Burks S, et al. 2013. Biomarkers for the clinical differential diagnosis in traumatic brain injury: A systematic review. CNS Neurosci Therapeut 19:556-565.
Zhi XL, Li CY, Xue M, et al. 2016. Changes in cognitive function due to combined propofol and remifentanil treatment are associated with phosphorylation of tau in the hippocampus, abnormal total water and calcium contents of the brain, and elevated serum S100β levels. Eur Rev Med Pharmacol Sci 20:2156-2162.
