Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery (PEACOG): a randomised controlled trial

摘要: Summary Background For some surgical procedures to be done, a patient's blood circulation needs stopped. In such situations, the maintenance of flow brain is perceived beneficial even in presence deep hypothermia. We aimed assess benefits antegrade cerebral perfusion (ACP) compared with hypothermic circulatory arrest (DHCA). Methods Patients aged 18–80 years undergoing pulmonary endarterectomy surgery UK centre (Papworth Hospital, Cambridge) were randomly assigned computer generated sequence receive either DHCA for periods up 20 min at 20°C or ACP (1:1 ratio). The primary endpoint was change cognitive function 12 weeks after surgery, as assessed by trail-making A and B tests, Rey auditory verbal learning test, grooved pegboard test. assessors masked treatment allocation. Primary analysis intention treat. trial registered Current Controlled Trials, number ISRCTN84972261. Findings enrolled 74 196 screened patients (35 39 ACP). Nine crossed over from allow complete endarterectomy. At weeks, mean difference between two groups Z scores (the score baseline divided SD) three main tests 0·14 (95% CI −0·14 0·42; p=0·33) −0·06 (−0·38 0·25; p=0·69) 0·01 (−0·26 0·29; p=0·92) All showed improvement weeks. recorded no significant adverse events groups. had died (one each group). Interpretation Cognitive not impaired DHCA. recommend optimum modality surgery. Funding J P Moulton Charitable Foundation.