Around half of patients undergoing cardiac surgery suffer some form of post operative neurocognitive dysfunction, the most common being delirium. The DECIDE trial will assess whether adding intra and post operative dexmedetomidine to standard care of these patients alters the rates of delirium and post operative cognitive decline.
Patients who suffer from delirium are known to be at a significantly increased risk of subsequent diagnoses of dementia, however the precise pathophysiology of this is not yet known. One potential mechanism is that the stress and inflammation suffered during the perioperative period leads to a breakdown of neuronal tissue itself. This sub study will measure plasma levels of neurofilament light (NfL) - a biomarker of neuronal injury whose level in peripheral blood has been shown to be consistent with that in the CSF- in the larger DECIDE trial, with the aim of exploring the link between any clinical findings of the main trial, to NfL levels.
This will allow the comparison of NfL levels in not only the dexmedetomidine or standard care groups, but also to various haemodynamic and other anaesthetic factors- potentially informing future care for on pump cardiac surgery.
Dr Tim Marshall, Professor Rob Sanders, Dr Joanne Irons, Dr Bruce Cartwright, Royal Prince Alfred Hospital, and University of Sydney, NSW; Professor Gillian Heller, Dr Thomas Payne, University of Sydney, NSW; Associate Professor Lis Evered, Weill Cornell Medicine, New York USA; Associate Professor Stefan Dieleman, Westmead Hospital, NSW; Professor David Scott, St Vincent’s Hospital and University of Melbourne; Dr Kate Drummond, Royal Adelaide Hospital, South Australia.
The project was awarded A$69,889 funding through the ANZCA research grants program for 2025.