Amplitude-Integrated/Continuous Electroencephalography for Early Detection of Low Cardiac Output After Chest Closure in an Infant.

BACKGROUND

Weaning from cardiopulmonary bypass in pediatric cardiac surgery is challenging, especially after prolonged procedures. Delayed chest closure may be necessary in cases of low cardiac output syndrome (LCOS) to support hemodynamic recovery. Although near-infrared spectroscopy is standard for neuromonitoring, amplitude-integrated electroencephalography (aEEG) and continuous electroencephalography (cEEG) are emerging tools.

CASE SUMMARY: We report the case of a 6-month-old infant with transposition of the great arteries who required delayed chest closure after surgical repair. LCOS recurred after chest closure on postoperative day 3 despite stable near-infrared spectroscopy values. Retrospective aEEG/cEEG analysis, unintentionally initiated before closure, showed early EEG abnormalities preceding clinical signs, which were resolved after chest reopening.

DISCUSSION: This case highlights the potential of aEEG/cEEG to detect early cerebral compromise due to LCOS, even when conventional monitoring appears normal, an association not well established in the literature.

TAKE-HOME MESSAGE: Cerebral distress may be detected earlier with aEEG compared with standard monitoring, supporting timely LCOS identification and management.