Electrical impedance tomography provides information of brain injury during total aortic arch replacement through its correlation with relative difference of neurological biomarkers

• Published in: Scientific reports Vol. 14; no. 1; pp. 14236 - 16
• Main Authors: Guo, Yitong, Yang, Chen, Zhu, Wenjing, Zhao, Rong, Ren, Kai, Duan, Weixun, Liu, Jincheng, Ma, Jing, Chen, Xiuming, Liu, Benyuan, Xu, Canhua, Jin, Zhenxiao, Shi, Xuetao
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 20.06.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 639/166/985; 639/166/987; 692/700/1421/65; Adult; Aged; Aorta, Thoracic - surgery; Aortic arch; Aortic Dissection - blood; Aortic Dissection - surgery; Biomarkers; Biomarkers - blood; Brain Injuries - blood; Brain Injuries - etiology; Brain Injuries - surgery; Brain injury; Dissection; Electric Impedance; Electrical impedance; Female; Glial fibrillary acidic protein; Hospitals; Humanities and Social Sciences; Humans; Hypoxia; Impedance; Intensive care units; Male; Middle Aged; multidisciplinary; Neurological complications; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; S100b protein; Science; Science (multidisciplinary); Surgery; Tau protein; Tomography; Tomography - methods; Traumatic brain injury; Variation
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-65203-0

Postoperative neurological dysfunction (PND) is one of the most common complications after a total aortic arch replacement (TAAR). Electrical impedance tomography (EIT) monitoring of cerebral hypoxia injury during TAAR is a promising technique for preventing the occurrence of PND. This study aimed to explore the feasibility of electrical impedance tomography (EIT) for warning of potential brain injury during total aortic arch replacement (TAAR) through building the correlation between EIT extracted parameters and variation of neurological biomarkers in serum. Patients with Stanford type A aortic dissection and requiring TAAR who were admitted between December 2021 to March 2022 were included. A 16-electrode EIT system was adopted to monitor each patient’s cerebral impedance intraoperatively. Five parameters of EIT signals regarding to the hypothermic circulatory arrest (HCA) period were extracted. Meanwhile, concentration of four neurological biomarkers in serum were measured regarding to time before and right after surgery, 12 h, 24 h and 48 h after surgery. The correlation between EIT parameters and variation of serum biomarkers were analyzed. A total of 57 TAAR patients were recruited. The correlation between EIT parameters and variation of biomarkers were stronger for patients with postoperative neurological dysfunction (PND(+)) than those without postoperative neurological dysfunction (PND(−)) in general. Particularly, variation of S100B after surgery had significantly moderate correlation with two parameters regarding to the difference of impedance between left and right brain which were MRAI abs and TRAI abs (0.500 and 0.485 with p < 0.05, respectively). In addition, significantly strong correlations were seen between variation of S100B at 24 h and the difference of average resistivity value before and after HCA phase (ΔARV HCA ), the slope of electrical impedance during HCA (k HCA ) and MRAI abs (0.758, 0.758 and 0.743 with p < 0.05, respectively) for patients with abnormal S100B level before surgery. Strong correlations were seen between variation of TAU after surgery and ΔARV HCA , k HCA and the time integral of electrical impedance for half flow of perfusion (TARV HP ) (0.770, 0.794 and 0.818 with p < 0.01, respectively) for patients with abnormal TAU level before surgery. Another two significantly moderate correlations were found between TRAI abs and variation of GFAP at 12 h and 24 h (0.521 and 0.521 with p < 0.05, respectively) for patients with a normal GFAP serum level before surgery. The correlations between EIT parameters and serum level of neurological biomarkers were significant in patients with PND, especially for MRAI abs and TRAI abs , indicating that EIT may become a powerful assistant for providing a real-time warning of brain injury during TAAR from physiological perspective and useful guidance for intensive care units.