Neuromonitoring and neuroprotection during neonatal aortic arch surgery: A United Kingdom and Ireland survey
Bibliographic record
Abstract
IntroductionNeonatal aortic arch surgery is associated with neurological morbidity of varying severity which is detected and potentially limited through neuroprotective strategies. We conducted a survey of healthcare professionals at all neonatal cardiac surgery centres in the United Kingdom and Ireland to determine current intraoperative neuromonitoring and neuroprotection practice.MethodsAn online cross-sectional survey was sent to congenital cardiac surgeons, cardiac anaesthetists, clinical perfusion scientists, and clinical neurophysiology professionals in all 12 level 1 paediatric cardiac surgical centres. Information was sought on their current clinical practice in neonates undergoing aortic arch surgery, including pharmacological management, cardiopulmonary bypass, acid-base and blood pressure management, neuromonitoring, and hypothermic circulatory arrest, and the feasibility and willingness to participate in a future clinical trial of neuroprotective strategies in these patients.ResultsWe received 55 (34%) responses, including representatives of all four clinical disciplines in 9 (75%) centres. Cooling to a nasopharyngeal temperature of 18°C before hypothermic circulatory arrest, selective antegrade cerebral perfusion, and near-infrared spectroscopy (NIRS) monitoring are common practice, whereas pharmacology, acid-base management, blood pressure and flow parameters, and NIRS-based interventions vary. In 7 (58%) centres, respondents from all four disciplines were willing to consider participation in a future clinical trial on neuroprotection.ConclusionsAspects of intraoperative neuroprotection and neuromonitoring are common across centres, although key areas of practice differ between practitioners and institutions. Most respondents were willing to participate in a future multi-centre clinical trial, which suggests clinical equipoise in the optimal strategy to protect the neonatal brain during aortic arch surgery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".