Gregory W. Fischer, MD, Hung-Mo Lin, PhD, Marina Krol, PhD, Maria F

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Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery Gregory W. Fischer, MD, Hung-Mo Lin, PhD, Marina Krol, PhD, Maria F. Galati, MBA, Gabriele Di Luozzo, MD, Randall B. Griepp, MD, David L. Reich, MD The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 3, Pages 815-821 (March 2011) DOI: 10.1016/j.jtcvs.2010.05.017 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 CONSORT diagram of 31 patients undergoing elective thoracic aortic surgery with deep hypothermic circulatory arrest (DHCA). SAO, Severe adverse outcome; Scto2, cerebral tissue oxygen saturation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 815-821DOI: (10.1016/j.jtcvs.2010.05.017) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Area under the threshold (AUT). AUT (present) = AUT (past) + (Scto2 Threshold − Scto2 value) × sample rate. Scto2, Cerebral tissue oxygen saturation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 815-821DOI: (10.1016/j.jtcvs.2010.05.017) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Temporal pattern of Scto2 values during the perioperative course. Summary box plot is based on the median, quartiles, and extreme Scto2 values. The box represents the interquartile range, which contains 50% of Scto2 values. The whiskers are lines that extend from the box to the highest and lowest Scto2 values, excluding outliers. A line across the box indicates the median. The Scto2 values reported in the box plot are the mean of left and right forehead cerebral oximetry sensor values. Key to events: Post Induction, Scto2 right after sensors placed on head during post induction; Pre CPB, Scto2 2 minutes before onset of CPB; Temp20C, Scto2 plateau for those subjects with initial hypothermia to 20°C; DHCA Onset, maximum Scto2 value during deep hypothermia just before DHCA onset; DHCA +5 min, Scto2 5 minutes after onset of DHCA; DHCA +10 min, Scto2 10 minutes after onset of DHCA; DHCA +15 min, Scto2 15 minutes after onset of DHCA; DHCA +20 min, Scto2 20 minutes after onset of DHCA; DHCA +25 min, Scto2 25 minutes after onset of DHCA; DHCA +30 min, Scto2 30 minutes after onset of DHCA; DHCA +35 min, Scto2 35 minutes after onset of DHCA; End DHCA +15 min, Scto2 15 minutes after DHCA; Chest Closed, Scto2 right after end of surgery. N is the number of subjects out of 30 that had each of the events; Scto2, Cerebral tissue oxygen saturation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 815-821DOI: (10.1016/j.jtcvs.2010.05.017) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Odds ratios for SAO for incremental exposure time to Scto2 values under specific thresholds. For every 5% decrease in the absolute Scto2 threshold, the incremental exposure time to achieve a given odds ratio (for SAO) decreased by half for Scto2 thresholds between 55% and 65%. C-statistics of time under the threshold for SAO were 0.77, 0.81 and 0.83 and for Scto2 thresholds of 55, 60, and 65%, respectively. The odds of having a SAO roughly doubled for every 10 years' increase in age. SAO, Severe adverse outcome; Scto2, cerebral tissue oxygen saturation. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 815-821DOI: (10.1016/j.jtcvs.2010.05.017) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions