TABLE 3.
Interventions
| Type of study | Summary | Reference | |
|---|---|---|---|
| Evidence-based interventions | |||
| Avoiding prolonged intubation times | Meta-analysis | Strongest intraoperative continuous risk factor in meta-analysis | Greaves et al46 |
| Heparin-coated bypass tubing | RCT | Non–heparin-coated group showed changes in executive function and attention | Baufreton et al38 |
| Maintaining adequate blood flow during CPB | Prospective cohort | Lower middle cerebral artery blood flow in patients who developed NCD | Bukauskiene et al27 |
| Intraoperative glucose control | RCT | Small improvement in verbal learning and recall | Schricker et al32 |
| Slower rewarming from hypothermia | RCT | Slower rewarming associated with less NCD using multivariate analysis | Grigore et al14 |
| Avoiding multiple aortic crossclamps | RCT | Multiple aortic crossclamp had 30% new NCD at 6 mo vs 9% for single crossclamp | Hammon et al50 |
| Cerebral oximetry monitoring and avoiding hypoxia | RCT | NCD incidence at 7 d was 52% without cerebral oximetry vs 28%11 | Slater et al10; Colak et al11; Uysal et al59 |
| Personalized MAP goals | RCT | Improved memory testing at 4 to 6 wk in patients with personalized MAP goal | Hogue et al71 |
| Avoiding postoperative AKI | Retrospective cohort | Increased development of dementia compared with matched controls (HR, 1.88) | Tsai et al73 |
| Inconclusive evidence | |||
| Type of anesthesia | Literature review | No strong evidence supporting use of specific type of anesthesia to reduce NCD | Lomivorotov et al21 |
| Off-pump vs on-pump CABG | RCT, prospective cohort, and meta-analysis | Mixed results. No significant difference in meta-analysis | Hernandez et al6; Selnes et al61; Marasco et al62 |
| Use of cardiotomy suction with cell saver processing | RCT | No difference in NCD among groups with and without blood processing | Rubens et al51; Djaiani et al52 |
| Appear to not affect NCD | |||
| Corticosteroids | RCT | High-dose corticosteroids do not appear to reduce risk of NCD | Glumac et al12; Ottens et al13 |
| Red blood cell transfusions | Prospective cohort study | Blood transfusion does not appear to reduce risk of NCD | Gorvitovskaia et al23 |
| Complement blockade | RCT | No effect of complement blockade with pexelizumab on NCD | Mathew et al55 |
| Hyperoxygenation | RCT | No difference in NCD between intraoperative normoxia and hyperoxia patients | Shaefi et al60 |
RCT, Randomized control trial; CPB, cardiopulmonary bypass; NCD, neurocognitive decline; MAP, mean arterial blood pressure; AKI, acute kidney injury; HR, hazard ratio; CABG, coronary artery bypass grafting.