Perioperative EEG background and discharge abnormalities in children undergoing cardiac surgery: a prospective single-centre observational study

Rouyi Lin; Na Du; Jinqing Feng; Jianbin Li; Lijuan Li; Yanqin Cui; Shuyao Ning; Mingjie Zhang; Guodong Huang; Huaizhen Wang; Minghui Zou; Li Ma; Xinxin Chen; Jia Li

doi:10.1016/j.bja.2023.04.042

Perioperative EEG background and discharge abnormalities in children undergoing cardiac surgery: a prospective single-centre observational study

Br J Anaesth. 2023 Aug;131(2):360-372. doi: 10.1016/j.bja.2023.04.042. Epub 2023 Jun 14.

Authors

Rouyi Lin¹, Na Du², Jinqing Feng¹, Jianbin Li², Lijuan Li², Yanqin Cui², Shuyao Ning³, Mingjie Zhang⁴, Guodong Huang², Huaizhen Wang², Minghui Zou², Li Ma², Xinxin Chen², Jia Li⁵

Affiliations

¹ Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China; Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
² Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China; Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China.
³ Department of Electroneurophysiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Province, China.
⁴ Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Province, China.
⁵ Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China; Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong, China. Electronic address: jiali_beijing@126.com.

PMID: 37328305
DOI: 10.1016/j.bja.2023.04.042

Abstract

Background: We analysed the characteristics of abnormal electroencephalogram (EEG) patterns before, during, and 48 h after cardiac surgery in patients with heterogeneous congenital heart disease to assess their relationship to demographic and perioperative variables and to early patient outcomes.

Methods: In 437 patients enrolled in a single centre, EEG was evaluated for background (including sleep-wake cycle) and discharge (seizures, spikes/sharp waves, pathological delta brushes) abnormalities. Clinical data (arterial blood pressure, doses of inotropic drugs, and serum lactate concentrations) were recorded every 3 h. Postoperative brain MRI was performed before discharge.

Results: Preoperative, intraoperative, and postoperative EEG was monitored in 139, 215, and 437 patients, respectively. Patients with a degree of preoperative background abnormalities (n=40) had more severe intraoperative and postoperative EEG abnormalities (P<0.0001). Intraoperatively, 106/215 (49.3%) patients progressed into an isoelectric EEG. Longer durations of isoelectric EEG were associated with more severe postoperative EEG abnormalities and brain injury on MRI (Ps≤0.003). Postoperative background abnormalities occurred in 218/437 (49.9%) patients, and 119 (54.6%) of them had not recovered after surgery. Seizures occurred in 36/437 (8.2%) patients, spikes/sharp waves in 359/437 (82.2%), and pathological delta brushes in 9/437 (2.0%). Postoperative EEG abnormalities correlated with degree of brain injury on MRI (Ps≤0.02). Demographic and perioperative variables were significantly correlated with postoperative EEG abnormalities, which in turn correlated with adverse clinical outcomes.

Conclusions: Perioperative EEG abnormalities occurred frequently and correlated with numerous demographic and perioperative variables and adversely correlated with postoperative EEG abnormalities and early outcomes. The relation of EEG background and discharge abnormalities with long-term neurodevelopmental outcomes remains to be explored.

Keywords: brain injury; cardiac surgery; congenital heart disease; electroencephalogram; neurodevelopment; postoperative outcomes.

Publication types

Observational Study

MeSH terms

Brain Injuries* / complications
Cardiac Surgical Procedures* / adverse effects
Child
Electroencephalography
Humans
Patient Discharge
Prospective Studies
Seizures