Michael Swartz
Author-Scientist
Neurologic injury, such as a stroke or seizure after pediatric cardiac surgery, not only impacts the immediate health but can have lasting effects into adolescence and adulthood. Unfortunately, current intra-operative neurologic monitoring is not universally able to identify children at risk for injury. Although electroencephalogram (EEG) monitoring has shown promise in predicting neurologic injury, it often requires constant evaluation by a trained professional and is therefore impractical. However, quantitative EEG monitoring uses sophisticated mathematical algorithms that produce real-time graphical outputs that can be readily interpreted by any clinician. The current manuscript in Pediatric Neurology titled, “Quantitative Electroencephalography Alpha:Delta Ratio and Suppression Ratio Monitoring During Infant Aortic Arch Reconstruction,” provides the first step in using this technology during pediatric cardiac surgery.
Before we can better understand patterns associated with neurologic injury, we must first understand the progression of these parameters during the different phases of the operation. Variables such as the alpha:delta ratio, which measures the EEG background frequency within the slow delta and faster alpha range, is often used to evaluate cerebral ischemia. Within this vulnerable population, changes in the alpha:delta ratio were observed during all phases of the operation, and differences between the left and right cerebral hemispheres were associated with neurologic injury. Similarly, the suppression ratio may provide insight into the necessary rate of cooling and re-warming during cardiopulmonary bypass, a rate that is otherwise standard without patient feedback. The use of the new technology will be paramount as the care for children with congenital heart disease moves toward the future.