EEG-based Neuromonitoring Improves Identification Of Neural Threats During Cardiac Surgery
Thomas Yeh, MD, PhD, Daniel Millan, MD, Christos Calaritis, CCP, John Miller, CCP, Daniel Adams, CNIM, Aida Sehic, MD, PhD.
Virginia Commonwealth University, Richmond, VA, USA.
Objectives: Neuromonitoring varies widely between centers. Strategies vary from none, to single modality (e.g. NIRS, near infrared spectroscopy), to multimodality techniques using EEG-based parameters that interrogate neural integrity. We hypothesized that EEG-based methods are more sensitive than single modalities in identifying neural threats.
Methods: 81 patients undergoing cardiac surgery were monitored with EEG (electroencephalogram, 8 channel), evoked potentials (somatosensory, brainstem auditory), NIRS (spinal and cerebral), and bilateral TCD (transcranial Doppler of middle cerebral artery blood flow velocity). Each patient served as their own control. An alarm was deemed false negative if NIRS or TCD would have failed to detect an alarm that was disclosed by the multimodality paradigm.
Results: 310 alarms (152 major) were detected. Alarms that would have been missed by NIRS or TCD in isolation (false negatives) are indicated.
Conclusions: EEG-based multimodality neuromonitoring identifies more intraoperative neural threats during cardiac surgery compared to single modalities. TCD and NIRS provide complementary information but are less sensitive in isolation. In addition, the resolution of an EEG-based alarm confirms whether or not a threat has been neutralized. These findings may have implications for the future of perioperative management as well.
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