A Coordinated Team Can Extinguish 95% Of Neural Threats Identified By EEG-Based Multimodality Neuromonitoring In Cardiac Surgery
Thomas Yeh, MD, PhD, Daniel Millan, MD, John Miller, CCP, Christos Calaritis, CCP, Daniel Adams, CNIM, Aida Sehic, MD PhD.
Virginia Commonwealth University, Richmond, VA, USA.
Objectives: Neuromonitoring strategies vary widely, ranging from none, to single modality near infrared spectroscopy (NIRS), to multimodality techniques that use EEG-based parameters to interrogate neurophysiologic integrity. We previously showed that multimodality methods more than doubled the detection rate of neural threats over NIRS alone. Though some believe these threats cannot be addressed, we hypothesized that neural threats could indeed be extinguished once detected.
Methods: 365 alarms were detected in 115 cardiac surgeries that were monitored with EEG, evoked potentials (somatosensory, brainstem auditory), NIRS (spinal and cerebral), and bilateral transcranial Doppler of middle cerebral artery blood flow velocity. Elapsed time from alarm detection to resolution was recorded along with the party that extinguished a given alarm.
Results: Of the 365 alarms identifed, 82% and 96% were extinguished on the first and second attempts respectively, using a coordinated approach between surgeon, anesthesiologist, and perfusionist. The mean time to alarm resolution in children was 4.9 +/- 1.4 minutes. 
Conclusions: A coordinated cardiac surgical team can efficiently extinguish most neural threats identified by EEG based multimodality neuromonitoring within 2 attempts in less than 5 minutes. In contrast to orthopedic or neurosurgery where the onus of extinguishing neural threats falls almost exclusively to the surgeon, in cardiac surgery that responsibility is shared between surgeon, anesthesia, and perfusion. Alarms that could not be extinguished were associated with neurologic injury.
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