Neurological Impact of Slower Rewarming during Bypass Surgery in Infants

Abstract: Background Hypothermia is a neuroprotective strategy during cardiopulmonary bypass. Rewarming entailing a rapid rise in cerebral metabolism might lead to secondary neurological sequelae. In this pilot study, we aimed to validate the hypothesis that a slower rewarming rate would lower the risk of cerebral hypoxia and seizures in infants. Methods This is a prospective, clinical, single-center study. Infants undergoing cardiac surgery in hypothermia were rewarmed either according to the standard (+1°C in < 5 minutes) or a slow (+1°C in > 5–8 minutes) rewarming strategy. We monitored electrocortical activity via amplitude-integrated electroencephalography (aEEG) and cerebral oxygenation by near-infrared spectroscopy during and after surgery. Results Fifteen children in the standard rewarming group (age: 13 days [5–251]) were cooled down to 26.6°C (17.2–29.8) and compared with 17 children in the slow-rewarming group (age: 9 days [4–365]) with a minimal temperature of 25.7°C (20.1–31.4). All neonates in both groups (n = 19) exhibited suppressed patterns compared with 28% of the infants > 28 days (p < 0.05). During rewarming, only 26% of the children in the slow-rewarming group revealed suppressed aEEG traces (vs. 41%; p = 0.28). Cerebral oxygenation increased by a median of 3.5% in the slow-rewarming group versus 1.5% in the standard group (p = 0.9). Our slow-rewarming group revealed no aEEG evidence of any postoperative seizures (0 vs. 20%). Conclusion These results might indicate that a slower rewarming rate after hypothermia causes less suppression of electrocortical activity and higher cerebral oxygenation during rewarming, which may imply a reduced risk of postoperative seizures.

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch

References and Relationships

• Bibliographic citation: Neurological Impact of Slower Rewarming during Bypass Surgery in Infants ; volume:72 ; number:S 03 ; year:2024 ; pages:e7-e15 ; 03 ; The thoracic and cardiovascular surgeon ; 72, Heft S 03 (2024), e7-e15, 03

Contributors, Places and Time

• Contributor: Muehlschlegel, Geeske ; Kubicki, Rouven ; Jacobs-LeVan, Julia ; Kroll, Johannes ; Klemm, Rolf ; Humburger, Frank ; Stiller, Brigitte ; Fleck, Thilo

Further information

• DOI: 10.1055/s-0044-1787650
• URN: urn:nbn:de:101:1-2408081138395.273833796304
• Rights: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 14.08.2025, 10:59 AM CEST