• Magruder J Trent JT Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore MD. Electronic address: jmagrud3@jhmi.edu., Charles D Fraser, Joshua C Grimm, Todd C Crawford, Claude A Beaty, Alejandro Suarez-Pierre, Ronald L Hayes, Michael V Johnston, and William A Baumgartner.
• Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore MD. Electronic address: jmagrud3@jhmi.edu.
• J. Cardiothorac. Vasc. Anesth. 2018 Dec 1; 32 (6): 2485-2492.

ObjectiveThe authors sought to assess the relationship between low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) and a neuron-specific biomarker of neurologic injury, ubiquitin C-terminal hydrolase L1 (UCH-L1).DesignRetrospective analysis of patient charts and prospectively collected blood samples.SettingUniversity-affiliated tertiary care hospital.ParticipantsAdult patients undergoing cardiac surgery on CPB.InterventionsSerum UCH-L1 levels were drawn at baseline and 6 and 24 hours after CPB cessation. DO2 was computed from perfusion records, with area-under-the-curve (AUC) computations performed to account for distance of DO2 excursions below predefined DO2 thresholds and the amount of time spent below them. Strokes were defined radiographically using computed tomography and magnetic resonance imaging.Measurements And Main ResultsForty-three adults were included (median age 65 y, interquartile range 59-72). Three patients experienced strokes (imaged at 2, 7, and 8 d postoperatively). Most patients underwent isolated coronary artery bypass grafting (41%, 18 patients) or isolated aortic valve replacement (30%, 13). Median UCH-L1 levels differed from baseline to 6 and 24 hours after CPB (40, 232, and 166 pg/mL, respectively; p < 0.001). On multivariable linear regression analysis controlling for baseline and surgical variables, only DO2 AUC <225 was significantly associated with 6-hour UCH-L1 levels (p = 0.001), whereas only DO2 AUC <300 was significantly associated with 24- hour levels (p < 0.001). The 3 patients who experienced radiographic strokes had nonsignificantly elevated 24-hour UCH-L1 levels compared with control patients (585 v 151 pg/mL, p = 0.11).ConclusionsThis is the first study to demonstrate an independent association between DO2 during CPB and elevations of a brain injury biomarker; additional study is needed to clarify the clinical significance of these results.Copyright © 2018 Elsevier Inc. All rights reserved.

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