{{Short description|Transient neurocognitive deficit after surgery using heart-lung machine}}

'''Postperfusion syndrome''', also known as "'''pumphead'''", is a constellation of [[neurocognitive]] impairments attributed to [[cardiopulmonary bypass]] (CPB) during [[cardiac surgery]]. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, [[short-term memory]], fine motor function, and speed of mental and motor responses.<ref name="Jenson">{{cite journal |vauthors=Jensen B, Hughes P, Rasmussen L, Pedersen P, Steinbrüchel D | title = Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial. | journal = Circulation | volume = 113 | issue = 24 | pages = 2790–5 | year = 2006 | pmid = 16769915 | doi = 10.1161/CIRCULATIONAHA.105.587931| doi-access = free }}</ref> Studies have shown a high incidence of neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment.<ref name="Jenson"/><ref name="VanDijk">{{cite journal |vauthors=Van Dijk D, Jansen E, Hijman R, Nierich A, Diephuis J, Moons K, Lahpor J, Borst C, Keizer A, Nathoe H, Grobbee D, De Jaegere P, Kalkman C | title = Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. | journal = JAMA | volume = 287 | issue = 11 | pages = 1405–12 | year = 2002 | pmid = 11903027 | doi = 10.1001/jama.287.11.1405| doi-access = }}</ref>

==Evidence== A study by Newman et al. at [[Duke University Medical Center]] showed an increased incidence of cognitive decline after [[coronary artery bypass surgery]] (CABG), both immediately (53 percent at discharge from [[hospital]]) and over time (36 percent six weeks, 24 percent at six months, and 42 percent at five years).<ref name="Newman">{{cite journal |vauthors=Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J | title = Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. | journal = N Engl J Med | volume = 344 | issue = 6 | pages = 395–402 | year = 2001 | pmid = 11172175 | doi = 10.1056/NEJM200102083440601| doi-access = free }}</ref> This study shows an association of neurocognitive decline with CABG, but does not show [[Correlation does not imply causation|causation]]; the study lacks a [[control group]] and is considered [[Evidence-based medicine#Assessing the quality of evidence|level II-3 evidence]]. Also, the statistical calculation of cognitive decline has been demonstrated as the least reliable due to practice effects, measurement error and the regression to the mean phenomenon.<ref name="Raymond">{{cite journal |vauthors=Raymond P, Hinton-Bayre A, Radel M, Ray M, Marsh N | title = Assessment of statistical change criteria used to define significant change in neuropsychological test performance following cardiac surgery. | journal = Eur J Cardiothorac Surg | volume = 29 | issue = 1 | pages = 82–88 | year = 2006 | pmid = 16337395 | doi = 10.1016/j.ejcts.2005.10.016| doi-access = free }}</ref>

Subsequent studies have compared "on-pump" CABG to [[off-pump coronary artery bypass]] (OPCAB)—essentially establishing controls to compare the incidence of neurocognitive decline in CABG with and without the use of CPB. A small study (60 patients total, 30 in each treatment arm) by Zamvar et al. demonstrated neurocognitive impairment was worse for the on-pump group both 1 week and 10 weeks postoperatively.<ref name="Zamvar">{{cite journal |vauthors=Zamvar V, Williams D, Hall J, Payne N, Cann C, Young K, Karthikeyan S, Dunne J | title = Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial. | journal = BMJ | volume = 325 | issue = 7375 | pages = 1268 | year = 2002 | pmid = 12458242 | doi = 10.1136/bmj.325.7375.1268 | pmc = 136922}}</ref> A larger study (281 patients total) by Van Dijk et al. showed CABG surgery without cardiopulmonary bypass improved cognitive outcomes 3 months after the procedure, but the effects were limited and became negligible at 12 months.<ref name="VanDijk"/> Furthermore, the Van Dijk study showed no difference between the on-pump and off-pump groups in quality of life, [[stroke]] rate, or all-cause [[death|mortality]] at 3 and 12 months. A study by Jenson et al. published in Circulation found no significant difference in the incidence of cognitive dysfunction 3 months after either OPCAB or conventional on-pump CABG.<ref name="Jenson"/>

==Neurocognitive deficit as a consequence of vascular disease== A study by McKhann et al.<ref name="McKhann">{{cite journal |vauthors=McKhann G, Grega M, Borowicz L, Bailey M, Barry S, Zeger S, Baumgartner W, Selnes O | title = Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. | journal = Neurology | volume = 65 | issue = 7 | pages = 991–9 | year = 2005 | pmid = 16107605 | doi = 10.1212/01.wnl.0000175220.78475.99| s2cid = 21972340 }}</ref> compared the neurocognitive outcome of people with [[coronary artery disease]] (CAD) to heart-healthy controls (people with no cardiac risk factors). People with CAD were subdivided into treatment with CABG, OPCAB and non-surgical medical management. The three groups with CAD all performed significantly lower at baseline than the heart-healthy controls. All groups improved by 3 months, and there were minimal intrasubject changes from 3 to 12 months. No one consistent difference between the CABG and off-pump patients was observed. The authors concluded patients with long-standing coronary artery disease have some degree of cognitive dysfunction secondary to [[cerebrovascular]] disease before surgery; there is no evidence the [[cognitive test]] performance of bypass surgery patients differed from similar control groups with coronary artery disease over a 12-month follow-up period. A related study by Selnes et al.<ref name="Selnes">{{cite journal |vauthors=Selnes O, Grega M, Borowicz L, Barry S, Zeger S, Baumgartner W, McKhann G | title = Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls. | journal = Ann Thorac Surg | volume = 79 | issue = 4 | pages = 1201–9 | year = 2005 | pmid = 15797050 | doi = 10.1016/j.athoracsur.2004.10.011}}</ref> concluded patients with coronary artery bypass grafting did not differ from a comparable nonsurgical control group with coronary artery disease 1 or 3 years after baseline examination. This finding suggests that late cognitive decline after coronary artery bypass grafting previously reported by Newman et al. may not be specific to the use of cardiopulmonary bypass, but may also occur in patients with very similar risk factors for cardiovascular and cerebrovascular disease.<ref name="Newman"/>

==Documentary film== In 2020, Australian film director [[Andrew Pike]] released ''Pumphead'', a documentary about the condition. The film explores the experiences of eight patients following major heart surgery, describing their experiences with postperfusion syndrome. The filmmaker Andrew Pike experienced pumphead himself, following open-heart surgery in 2011.<ref name="pumphead-film-press-kit">{{cite web |title=Pumphead Press Kit |url=https://www.roninfilms.com.au/get/files/17033/pumphead-press-kit-16-10-20.pdf |publisher=Ronin Films |access-date=18 January 2022 |date=16 October 2020}}</ref> The film introduces the concept of [[post-traumatic growth]], as a positive psychological change that can follow traumatic experiences such as pumphead.<ref name="pumphead-film-press-kit" />

== See also == * [[Heparin-coated blood oxygenator]] * [[Postoperative cognitive dysfunction]] * [[Post-chemotherapy cognitive impairment]] (aka "chemo brain") * [[Vasoplegic syndrome]]

== References == {{reflist}}

==Further reading== * {{cite journal | pmid = 16785349 | doi=10.1161/CIRCULATIONAHA.106.632711 | volume=113 | issue=24 | title=Can cognition survive heart surgery? |date=June 2006 | author=Samuels MA | journal=Circulation | pages=2784–6| doi-access=free }} * {{cite journal |vauthors=Jensen B, Hughes P, Rasmussen L, Pedersen P, Steinbrüchel D | title = Cognitive outcomes in elderly high-risk patients after off-pump versus conventional coronary artery bypass grafting: a randomized trial. | journal = Circulation | volume = 113 | issue = 24 | pages = 2790–5 | year = 2006 | pmid = 16769915 | doi = 10.1161/CIRCULATIONAHA.105.587931| doi-access = free }} * ''Cardiac Surgery In The Adult'' Chapter 11D [http://cardiacsurgery.ctsnetbooks.org/cgi/content/full/2/2003/361#NEUROLOGIC_INJURY Organ Damage]

[[Category:Neurological disorders]] [[Category:Cardiac surgery]] [[Category:Syndromes]]