Neuropsychologic outcome after deep hypothermic circulatory arrest in adults

Introduction: Pediatric patients undergoing prolonged periods of deep hypot hermic circulatory arrest have been found to experience long-term deficits in cognitive function. However, there is limited information of this type i n adult patients who are undergoing deep hypothermic circulatory arrest for thoracic aortic repairs. Methods: One hundred forty-nine patients undergoi ng elective cardiac or thoracic aortic operations were evaluated preoperati vely; 106 patients were evaluated early in the postoperative period (EARLY) , and 77 patients were evaluated late in the postoperative period (LATE) wi th a battery of neuropsychologic tests. Seventy-three patients had routine cardiac operations without deep hypothermic circulatory arrest, and 76 pati ents with deep hypothermia circulatory arrest were divided into 2 subgroups : those with 1 to 24 minutes of deep hypothermia circulatory arrest (n = 36 patients) and those with 25 minutes or more of deep hypothermic circulator y arrest (n = 40 patients). The neuropsychologic test battery consisted of 8 tests encompassing 5 domains: attention, processing speed, memory, execut ive function, and fine motor function. Data were normalized to baseline val ues, and changes from baseline were analyzed by analysis of covariance, mul tivariate logistic regression, and survival functions. Results: in all doma ins, poor performance or inability to be tested EARLY were significant pred ictors of poor performance LATE (odds ratio, 5.27; P <.01), Deep hypothermi c circulatory arrest of 25 minutes or more and advanced age were significan t predictors of poor performance LATE for the memory and fine motor domains . Deep hypothermic circulatory arrest of 25 minutes or more (odds ratio, 4. 0; P =.02) was a determinant of prolonged hospital stay (>21 days). Conclus ion: Deep hypothermia circulatory arrest of 25 minutes or more and advanced age mere associated with memory and fine motor deficits and with prolonged hospital stay.