ENGAGES-CANADA
Trial question
What is the role of EEG-guided anesthesia in older adults undergoing cardiac surgery?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
24.8% female
75.2% male
N = 1131
1131 patients (282 female, 858 male)
Inclusion criteria: adults aged ≥ 60 years undergoing cardiac surgery
Key exclusion criteria: preoperative delirium; hearing impairment; blindness; unable to speak or write French or English; previous experience of intraoperative awareness
Interventions
N=562 EEG-guided anesthesia (EEG waveforms and derived parameters were shown and clinicians were encouraged to minimize EEG suppression)
N=569 usual care (general anesthesia administered without EEG monitoring)
Primary outcome
Rate of delirium during postoperative days 1-5
18.15
18.1
18.1 %
13.6 %
9.1 %
4.5 %
0.0 %
EEG-guided
anesthesia
Usual
care
No significant
difference ↔
No significant difference in the rate of delirium during postoperative days 1-5 (18.15% vs. 18.1%; AD 0.05%, 95% CI -4.57 to 4.67)
Secondary outcomes
No significant difference in time spent in the ICU (3 days vs. 3 days; )
No significant difference in hospital length of stay (9 days vs. 9 days; )
No significant difference in the rate of severe delirium on postoperative days 1-5 (6.6% vs. 5.5%; AD 1.08%, 95% CI -1.94 to 4.12)
Safety outcomes
No significant difference in adverse and serious adverse events.
Conclusion
In adults aged ≥ 60 years undergoing cardiac surgery, EEG-guided anesthesia was not superior to usual care with respect to the rate of delirium during postoperative days 1-5.
Reference
Alain Deschamps, Arbi Ben Abdallah, Eric Jacobsohn et al. Electroencephalography-Guided Anesthesia and Delirium in Older Adults After Cardiac Surgery: The ENGAGES-Canada Randomized Clinical Trial. JAMA. 2024 Jun 10.
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