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Neurological Outcomes and Neuromonitoring in Cardiac Surgery.

Neurological injuries in the form of stroke, cognitive decline, and delirium are common complications in patients undergoing cardiac surgery and continue to be a leading cause of morbidity, mortality, and long-term disability. Patients with neurological complications of cardiac surgery have higher in-hospital mortality, longer hospitalizations, and a higher rate of discharge to intermediate-term and long-term care facilities. Although this places an obvious strain on already scarce health care resources, the more important outcome is the potentially devastating impact that these events can have on the lives of patients and their families. Even as the overall mortality in cardiac surgical patients continues to decline, adverse neurological outcomes remain an everpresent threat in this population. Advances in technology enable us to look more closely than ever before at the structure and function of the central nervous system (CNS). However, the precise pathophysiology of cerebral injury during cardiac surgery remains incompletely understood. Often considered to be primarily associated with systemic inflammation and embolization related to cardiopulmonary bypass (CPB), the pathophysiology of neurological injury is likely more complex and related to a number of patient-specific factors such as preexisting neurological dysfunction and extracardiac vascular disease. A number of preoperative stroke prediction models and risk assessment tools exist for cardiac surgical patients, but advances in intraoperative monitoring of the CNS and its application to the detection and prevention of cerebral injury have not consistently shown outcome benefit across wide populations.