Institutional members access full text with Ovid®

Changes in Cerebral Oxygen Saturation Correlate With S100B in Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Abu-Sultaneh, Samer MD1; Hehir, David A. MD2,3; Murkowski, Kathleen RRT, CCRC2; Ghanayem, Nancy S. MD2; Liedel, Jennifer MD2,4; Hoffmann, Raymond G. PhD5; Cao, Yumei PhD5,6; Mitchell, Michael E. MD6; Jeromin, Andreas PhD7; Tweddell, James S. MD6; Hoffman, George M. MD2,8

Pediatric Critical Care Medicine: March 2014 - Volume 15 - Issue 3 - p 219–228
doi: 10.1097/PCC.0000000000000055
Cardiac Intensive Care

Objectives: The relationship of cerebral saturation measured by near-infrared spectroscopy with serum biomarker of brain injury S100B was investigated in infants undergoing cardiac surgery with cardiopulmonary bypass.

Design: Prospective cohort study.

Setting: Single-center children’s hospital.

Patients: Forty infants between 1 and 12 months old weighing greater than or equal to 4 kg with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were enrolled.

Interventions: None.

Measurements and Main Results: Serum S100B was measured at eight time points over 72 hours using enzyme-linked immunosorbent assay. Physiologic data including arterial, cerebral, and somatic regional oxygen saturations measured by near-infrared spectroscopy were synchronously recorded at 1-minute intervals from anesthesia induction through 72 postoperative hours. The arterial-cerebral oxygen saturation difference was calculated as the difference between arterial saturation and cerebral regional saturation. Thirty-eight patients, 5.4 ± 2.5 months old, were included in the analysis; two were excluded due to the use of postoperative extracorporeal membrane oxygenation. Seventeen patients (44.7%) had preoperative cyanosis. S100B increased during cardiopulmonary bypass in all patients, from a median preoperative baseline of mean ± SE: 0.055 ± 0.038 to a peak of 0.610 ± 0.038 ng/mL, p less than 0.0001. Patients without preoperative cyanosis had a higher S100B peak at the end of cardiopulmonary bypass. Although the absolute cerebral regional saturation on cardiopulmonary bypass was not associated with S100B elevation, patients who had arterial-cerebral oxygen saturation difference greater than 50 at any time during cardiopulmonary bypass had a higher S100B peak (mean ± SE: 1.053 ± 0.080 vs 0.504 ± 0.039 ng/mL; p < 0.0001).

Conclusions: A wide cerebral arteriovenous difference measured by near-infrared spectroscopy during cardiopulmonary bypass is associated with increased serum S100B in the perioperative period and may be a modifiable risk factor for neurological injury.

1Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

2Division of Critical Care, Department of Pediatrics, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

3Division of Cardiology, Department of Pediatrics, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

4Division of Neonatology, Department of Pediatrics, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

5Division of Quantitative Health Sciences, Department of Pediatrics, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

6Division of Cardiothoracic Surgery, Department of Pediatrics, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

7Banyan Biomarkers Inc., Alachua, FL.

8Department of Pediatric Anesthesiology, Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.

This study was conducted at Children’s Hospital of Wisconsin during Dr. Abu-Sultaneh's pediatric critical care fellowship training.

Supported, in part, by Mend A Heart Foundation.

Dr. George M. Hoffman has received grant support from the National Institutes of Health (NIH). Dr. Mitchell is the cofounder of Ariosa Diagnostics and has received patents, royalties, stock options, grant support, and travel reimbursements from Ariosa Diagnostics. He has consulted for Abbott Labs and has also received grant support from Diagnostics, NIH, and the Mayo Clinic. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: David Hehir, MD, Assistant Professor, Pediatric Critical Care and Cardiology, Children’s Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, MS 671, Milwaukee, WI 53211. E-mail: dhehir@mcw.edu

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies