Pump Head â Fact or fiction? Cognitive outcome after off- versus on-pump coronary revascularisation: A meta-analysis. E. D. Kennedy,1 K. C. C. Choy,1 R. P. ...
Pump Head – Fact or fiction? Cognitive outcome after off- versus on-pump coronary revascularisation: A meta-analysis E. D. Kennedy,1 K. C. C. Choy,1 R. P. Alston,2 S. Chen,1 M. M. H. Farhan-Alanie,1 J. Anderson,1 Y. L. Ang,1 D. E. Moore,1 S. A. MacKenzie1 and R. A. Sykes1 1. Medical Student, University of Edinburgh Medical School, Edinburgh. 2. Consultant, Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh
Introduction • Pump head – cognitive impairment following CABG surgery • Rise of off-pump CABG in 1990s • Recent RCTs and meta-analyses fail to find a better outcome with off-pump CABG • Cognition measured by psychometric tests • Dichotomous or continuous outcomes?
Aim • Systematic review and meta-analysis – determine if cognitive impairment is associated with the use of CPB in CABG surgery.
Methods • • • •
Literature search yielded 13 randomised controlled trials. Systematic bias assessment Psychometric test battery based on Consensus Statement Change in test scores from baseline • Early (≤ 3 months) • Late (6-12 months)
Results – Early (≤3 months) Psychometric Test Auditory Verbal Learning
Offpump
Onpump
369
364
Mean Difference [95% CI] -0.29 [-2.25, 1.68] -10
Grooved Pegboard Trail-Making A
438 391
430 399
0
5
Digit Symbol
371 407
379 397
-20 -10
0
10
-10
0
10
-25
0
25
-5
0
5
Stroop Colour Word Test
302 215
305 213
20
-0.94 [-4.38, 2.50] -6.22 [-15.84, 3.40] I 2 = 51%
-50
20
50
-0.19 [-2.12, 1.74] -10
Digit Span
10
-2.08 [-6.82, 2.66]
-20
Trail-Making B
-5
0.22 [-0.38, 0.82] I 2 = 74%
-4
-2
0
10
2
4
-1.56 [-7.26, 4.14] -20 -10 0 10 20 Favours off-pump Favours on-pump
Results – Late (6-12 months) Psychometric Test Auditory Verbal Learning
Offpump
Onpump
286
263
Mean Difference [95% CI] -1.99 [-4.30, 0.33] -10
Grooved Pegboard
357
333
-5
0
5
0
10
-5
0
5
-25
0
25
-5
0
5
-3.61 [-8.50, 1.28] -20 -10
Trail-Making A
860
855
860
855
891
876
805
798
231
217
10
0.12 [-0.37, 0.60] -4
Stroop Colour Word Test
50
0.44 [-1.14, 2.01] -10
Digit Span
10
-2.54 [-9.72, 4.63] -50
Digit Symbol
20
0.11 [-2.18, 2.40] -10
Trail-Making B
10
-2
0
2
4
2.24 [-3.92, 8.40] -20 -10 0 10 20 Favours off-pump Favours on-pump
Discussion • Largest systematic review and meta-analysis to date. • Concurs with previous meta-analyses. • Limitations: • • • • •
Ineffective randomisation Psychometric testing performed too early Attrition rates Mood disturbances Lack of standardised surgical procedure
Conclusion • No significant difference in cognition after off- or on-pump CABG surgery • Cannot exclude that CABG surgery causes cognitive decline
Preoperative Test Scores
