Table 2.
American College of Cardiology/American Heart Association Scores and Conclusions for Grouped Manuscripts
| Group | No. | Final Score | Original Distribution of Scores | Final Conclusion |
|---|---|---|---|---|
| Blood gas management | 3 | Class IIB, Level B | Class IIB, Level B (7) Class III (no benefit), Level B (2) |
No data to demonstrate superiority of alpha vs pH stat blood gas management at long-term neurodevelopmental testing. It is reasonable to use either strategy. |
| Hematocrit | 3 | Class IIA, Level A | Class I, Level B (2) Class IIA, Level A (3) Class IIA, Level B (4) |
Avoiding extreme hemodilution can be beneficial/effective/useful. An exact lower limit for hematocrit has not been well defined but should probably not go below 24%. |
| EEG | 4 | Class III (no benefit), Level C | Class IIB, Level B (4) Class III (no benefit), Level B (2) Class III (no benefit), Level C (3) |
No data to show that EEG monitoring is associated with better or worse outcomes. Use of routine EEG monitoring cannot be recommended. |
| Cooling | 5 | Class III (no benefit), Level B | Class III (no benefit), Level B (9) | No data to support any difference in outcomes with any specific cooling strategy or duration. No specific cooling strategy can be recommended. |
| Glycemic control | 5 | Class III (harm), Level B | Class IIA, Level B (1) Class IIB, Level B (3) Class III (no benefit), Level B (4) Class III (harm), Level B (1) |
There is no evidence of benefit for tight glycemic control; however, there may be harm from hypoglycemia. Tight glycemic control is not indicated. |
| S100β | 12 | Class III (no benefit), Level B | Class III (no benefit), Level A (1) Class III (no benefit), Level B (2) Class III (no benefit), Level C (6) |
Measuring S100β has not been demonstrated to identify patients at increased risk of neurologic injury. Measurement of S100β is not indicated. |
| Transcranial Doppler (TCD) | 15 | Class III (no benefit), Level B | Class IIB, Level B (4) Class IIB, Level C (1) Class III (no benefit), Level A (1) Class III (no benefit), Level B (2) Class III (no benefit), Level C (1) |
The data concerning TCD is limited in quality. There is no evidence that the use of TCD is associated with improved neurodevelopmental outcomes. TCD monitoring may be considered. |
| NIRS | 35 | Class III (no benefit), Level B | Class IIB, Level B (2) Class IIB, Level C (2) Class III (no benefit), Level B (2) Class III (no benefit), Level C (3) |
The data concerning NIRS and neurodevelopmental outcomes are limited in quality. There is no consistent evidence that the use of NIRS is associated with improved neurodevelopmental outcomes. NIRS may be considered as a monitoring methodology. |
| DHCA/LFCPB/RCP | 44 | Class III (no benefit), Level B | Class IIB, Level B (2) Class III (no benefit), Level B (6) Class III (no benefit), Level C (1) |
Among the 3 commonly used perfusion strategies employed for neonatal cardiac surgery using cardiopulmonary bypass and deep hypothermia, none is clearly superior. No specific perfusion strategies can be recommended. |
DHCA/LFCPB/RCP = deep hypothermic arrest, low flow cardiopulmonary bypass, regional cerebral perfusion; EEG = electroencephalogram; NIRS = near-infrared spectroscopy.