Redesigning Cardiac Surgery to Reduce Neurologic Injury
Condition: Cardiovascular Disease; Surgery
MeSH terms: Cardiovascular Diseases
Study type: Observational

Summary: 
      Neurologic injuries are frequent and devastating complications following cardiac surgery.
      Previous work conducted by our research group and others has identified the principal
      mechanisms creating both overt and subtle neurologic injuries after cardiac surgery. Current
      work by our group has identified that the causes (thrombotic/lipid emboli, cerebral
      hypoperfusion & hypotension, and gaseous emboli) of these injuries are byproducts of
      processes of surgical and perfusion care. This insight suggests that the redesign of clinical
      strategies and techniques to prevent the occurrence of these intraoperative sources of damage
      may provide an opportunity to reduce the risk of neurologic injury after cardiac surgery.

      The goal of this research is to identify modifiable clinical strategies and techniques of
      surgical and perfusion care associated with the causes (thrombotic/lipid emboli, cerebral
      hypoperfusion & hypotension, and gaseous emboli) of neurologic injury secondary to coronary
      artery bypass graft (CABG) surgery, and subsequently to redesign these processes to reduce a
      patient's risk of a neurologic injury.
    

Detailed description: 
      The goal of this research is to identify modifiable clinical strategies and techniques of
      surgical and perfusion care associated with the causes (thrombotic/lipid emboli, cerebral
      hypoperfusion & hypotension, and gaseous emboli) of neurologic injury secondary to coronary
      artery bypass graft (CABG) surgery, and subsequently to redesign these processes to reduce a
      patient's risk of a neurologic injury. The following hypotheses will be addressed.

      Hypothesis #1a. Identifying alternative strategies for conducting processes of surgical and
      perfusion care will reveal opportunities to reduce the occurrence of causes of neurologic
      injury. The most common mechanisms creating neurologic injury, whether focal or global, after
      CABG surgery are thrombotic/lipid emboli, cerebral hypoperfusion & hypotension, and gaseous
      emboli. Processes of surgical and perfusion care are associated with the creation of each of
      these causes of neurologic injury.

      Hypothesis #1b. Redesigning processes of surgical and perfusion care to reduce
      thrombotic/lipid emboli, cerebral hypoperfusion & hypotension, and gaseous emboli during CABG
      surgery will result in reductions of tissue-level and neurologic injury. We will analyze sera
      for tissue-level brain injury as well as identify any new neurologic injuries present among
      patients undergoing CABG surgery. Redesigning CABG surgery to reduce thrombotic/lipid emboli,
      cerebral hypoperfusion & hypotension, and gaseous emboli will result in decreases in
      tissue-level and neurologic injury.

      Hypothesis #2. A regional quality improvement intervention will result in changes to surgical
      and perfusion techniques. Regional dissemination of the findings from Hypotheses #1a,b may be
      realized through focused quality improvement initiatives utilizing multidisciplinary clinical
      teams.
    

Intervention name(s): Quality improvement intervention
Intervention type(s): Other
Intervention description(s): determine the effectiveness of adopting quality improvement strategies to reduce embolization, hypotension and cerebral desaturation
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients undergoing cardiac surgery.
      
Biospecimen description: 
      Serum to study neurologic biomarker, Sb100.
    
Keywords: Neuro-monitoring; Quality Improvement; Cerebral emboli; Cerebral desaturation; Hypotension