Table 2.

Recommendations for measures to reduce brain injury during cardiac surgery.[3]

A membrane oxygenator and an arterial line filter (≤40 µM) should be used for CPB.	Class I (Level A)
Epiaortic ultrasound for detection of atherosclerosis of the ascending aorta.	Class I (Level B)
Hyperthermia should be avoided during and after CPB.	Class I (Level B)
A single aortic cross-clamp technique should be used for patients at risk for atheroembolism.	Class IIa (Level B)
During CPB in adults, α-stat pH management should be considered.	Class IIa (Level A)
Arterial line temperature during CPB rewarming should be limited to 37°C.	Class IIa (Level B)
NIRS monitoring should be considered, especially in high-risk patients.	Class IIb (Level B)
Arterial blood pressure should be maintained at >70 mmHg during CPB in high-risk patients.	Class IIb (Level B)
Serum glucose should be kept <140 mg/dL with an infusion of insulin.	Class IIb (Level C)
Transfusion of packed red blood cells should be considered in high-risk patients when hemoglobin is ≤7 g/dL or higher, depending on other patient-specific considerations.	Class IIb (Level C)
Processing cardiotomy suction aspirate with a cell-saver device as a means for preventing neurocognitive dysfunction.	Class Indeterminate (Level A)
There are currently no pharmacological neuroprotective agents with proven efficacy in humans.	Class Indeterminate (Level B)

Note: Class I: always acceptable, proven safe, and definitely useful; Class IIa: acceptable, safe, and useful. Reasonably prudent physicians can choose. Considered the intervention of choice by majority of physicians. Class IIb: acceptable, safe, and useful. Considered optional or alternative treatment by most experts; Class III: no evidence of benefit. Class Indeterminate: Intervention can be used, but evidence is insufficient to support efficacy.