Gold et al. [1616 Gold JP, Charlson ME, Williams-Russo P, Szatrowski TP, Peterson JC, Pirraglia PA, et al. Improvement of outcomes after coronary artery bypass: a randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg. 1995;110(5):1302-14; discussion 1311-4. doi:10.1016/S0022-5223(95)70053-6. https://doi.org/10.1016/S0022-5223(95)70...
], 1995 |
Parallel groups, randomized, prospective, double-blind trial |
- High MAP (80-100) vs. low MAP (50-60) - The alpha-stat protocol 17 for blood gas management was used, and body temperature was cooled to 28°C to 30°C. If MAP increased above the target level and was unresponsive to fentanyl or midazolam, sodium nitroprusside infusion was administered. If MAP fell below the target level, phenylephrine was used. If necessary, norepinephrine or metaraminol were added |
- Wechsler adult intelligence scale (WAIS-R) - Trail Making A and B - Grooved pegboard test (Pegs) - Boston Naming, Benton Visual Retention and Recognition Test - Controlled Oral Word Association - Mattis-Kovner Verbal Recall and Recognition, and Finger-Tapping Test - Ammons Quick Test - Control tests: CES-D and SF-36 Health Survey |
- A decline determined a priori by a panel of experts in the postoperative score in comparison to the preoperative score - POCD if occurred in three or more tests |
- Higher MAP during CPB can effectively improve outcomes after coronary bypass |
Charlson et al.[1717 Charlson ME, Peterson JC, Krieger KH, Hartman GS, Hollenberg JP, Briggs WM, et al. Improvement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure. J Card Surg. 2007;22(6):465-72. doi:10.1111/j.1540-8191.2007.00471.x. https://doi.org/10.1111/j.1540-8191.2007...
], 2007 |
Parallel groups, prospective, randomized, and double-blinded |
- High MAP (80) vs. custom MAP (≤90) - In the high MAP group: if MAP was low, a phenylephrine bolus of 5-15 mcg/kg was given to return MAP to the usual usage range; infusions of 10 mg/250 cc phenylephrine were also used, if necessary. If this was inadequate to maintain MAP, norepinephrine and/or metarainol infusions were given. If MAP was above the target MAP, nitroglycerin 1 mcg/kg bolus was given followed by an infusion of 0.5-20 mcg/kg/min as needed. If this was inadequate, sodium nitroprusside 1-15 mcg/kg/min was infused. In the custom group: patients had pressure maintained during full flow in their custom MAP using the same vasoactive drugs employed in the high MAP group |
- Wechsler Adult Intelligence Scale (WAIS-R) - Trail Making A and B - Grooved pegboard test (Pegs) - Boston Naming, Benton Visual Retention and Recognition Test - Controlled Oral Word Association - Mattis-Kovner Verbal Recall and Recognition, and Finger-Tapping Test - Ammons Quick Test - Control tests: CES-D and SF-36 Health Survey |
- A decline determined a priori by a panel of experts in the postoperative score in comparison to the preoperative score - POCD if occurred in three or more tests |
- There were no statistically significant differences between the high MAP group and the custom MAP group for cognitive complications |
Siepe et al. [1818 Siepe M, Pfeiffer T, Gieringer A, Zemann S, Benk C, Schlensak C, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. Eur J Cardiothorac Surg. 2011;4091):200-7. doi:10.1016/j.ejcts.2010.11.024. https://doi.org/10.1016/j.ejcts.2010.11....
], 2011 |
Parallel groups, prospective, randomized, and double-blinded |
- High MAP (80-90) vs. low MAP (60-70) - Arterial hypertension with norepinephrine (maximal dose 0.4 mg/kg/min) and hypotension with single 5-mg bolus of urapidil (maximal dose 0.1 mg/kg/min) |
- Mini-Mental-State Examination (MMSE) |
- Any score of 10 points under the preoperative score, together with a positive assessment by a psychologist, was considered delirium tests |
Maintenance of perfusion pressure at physiologic levels during normothermic CPB (80-90 mmHg) is associated with less early POCD and delirium |