Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery (PEACOG): a randomised controlled trial

Summary Background For some surgical procedures to be done, a patient's blood circulation needs to be stopped. In such situations, the maintenance of blood flow to the brain is perceived beneficial even in the presence of deep hypothermia. We aimed to assess the benefits of the maintenance of a...

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Bibliographic Details
Published in:The Lancet (British edition) 2011-10, Vol.378 (9800), p.1379-1387
Main Authors: Vuylsteke, Alain, Dr, Sharples, Linda, PhD, Charman, Gill, RN, Kneeshaw, John, FRCA, Tsui, Steven, FRCS, Dunning, John, FRCS, Wheaton, Ella, MSc, Klein, Andrew, FRCA, Arrowsmith, Joseph, FRCA, Hall, Roger, FRCA, Jenkins, David, FRCS
Format: Article
Language:English
Subjects:
Auditory discrimination learning
Biological and medical sciences
Blood circulation
blood flow
Blood Pressure
Brain
Cerebrovascular Circulation
Circulatory Arrest, Deep Hypothermia Induced - adverse effects
Clinical trials
Cognition
Cognitive ability
Computers
Cooling
Coronary vessels
Dissection
Endarterectomy
Female
General aspects
Hospitals
Humans
Hypertension
Hypertension, Pulmonary - etiology
Hypertension, Pulmonary - physiopathology
Hypertension, Pulmonary - surgery
Hypothermia
Internal Medicine
learning
Lung
Male
Medical research
Medical sciences
Middle Aged
Mortality
Motivation
Neuropsychological Tests
patients
Perfusion
Pulmonary Artery - surgery
Pulmonary Embolism - complications
R&D
randomized clinical trials
Research & development
Spectrum analysis
Surgery
Vascular Resistance
Veins & arteries
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Summary:Summary Background For some surgical procedures to be done, a patient's blood circulation needs to be stopped. In such situations, the maintenance of blood flow to the brain is perceived beneficial even in the presence of deep hypothermia. We aimed to assess the benefits of the maintenance of antegrade cerebral perfusion (ACP) compared with deep hypothermic circulatory arrest (DHCA). Methods Patients aged 18–80 years undergoing pulmonary endarterectomy surgery in a UK centre (Papworth Hospital, Cambridge) were randomly assigned with a computer generated sequence to receive either DHCA for periods of up to 20 min at 20°C or ACP (1:1 ratio). The primary endpoint was change in cognitive function at 12 weeks after surgery, as assessed by the trail-making A and B tests, the Rey auditory verbal learning test, and the grooved pegboard test. Patients and assessors were masked to treatment allocation. Primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN84972261. Findings We enrolled 74 of 196 screened patients (35 to receive DHCA and 39 to receive ACP). Nine patients crossed over from ACP to DHCA to allow complete endarterectomy. At 12 weeks, the mean difference between the two groups in Z scores (the change in cognitive function score from baseline divided by the baseline SD) for the three main cognitive tests was 0·14 (95% CI −0·14 to 0·42; p=0·33) for the trail-making A and B tests, −0·06 (−0·38 to 0·25; p=0·69) for the Rey auditory verbal learning test, and 0·01 (−0·26 to 0·29; p=0·92) for the grooved pegboard test. All patients showed improvement in cognitive function at 12 weeks. We recorded no significant difference in adverse events between the two groups. At 12 weeks, two patients had died (one in each group). Interpretation Cognitive function is not impaired by either ACP or DHCA. We recommend circulatory arrest as the optimum modality for patients undergoing pulmonary endarterectomy surgery. Funding J P Moulton Charitable Foundation.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(11)61144-6