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.
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
