RF92 USEFULNESS OF PATIENT-SPECIFIC NEAR-INFRARED SPECTROSCOPY-BASED ALGORITHMS FOR THE INTRAOPERATIVE MANAGEMENT DURING CARDIAC SURGERY

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Background: After a systematic review showing poor and conflicting results about the clinical effectiveness of near-infrared spectroscopy (NIRS)-based patient-specific goal-directed algorithms for the prevention of organ failure, sepsis and death in cardiac surgery patients, the proposal of this study was to evaluate if a NIRS-based specific algorithm could improve the intraoperative management, achieving an optimisation of cerebral oxygenation during cardiopulmonary bypass (CPB) combined with a restrictive blood red cell transfusion threshold. Methods: 168 patients were randomized into two groups: the NIRS-based algorithm Group, that included a restrictive red cell transfusion threshold (haematocrit 18%), and the control group, that had not a based algorithm. The primary outcome for the trial was cognitive function measured up to 3 months post-surgery. Secondary outcomes, including kidney and myocardial injury markers, adverse clinical events, blood transfusion and cost-effectiveness were compared between groups. Results: Of the 168 patients, 136 with complete follow-up data for the primary end point formed the analysis cohort. There was no difference between the groups with respect to neurocognitive impairment and for the secondary outcomes. Conversely, a subgroup analysis showed that in aortic arch surgery, for NIRS-based algorithm patients cognitive testing scores were higher in the verbal fluency domain (p < 0.01), whereas transfusion rates are similar in both groups (p > 0.05). Conclusions: Near-infrared spectroscopy-based algorithms for the management of CPB do not show clinical advantages except for aortic arch surgery patients.

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