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Postperfusion Syndrome: What You Should Know If You’re Living With “Pump Head”

What is Postperfusion Syndrome (“Pump Head”)?

Postperfusion syndrome (also known as “pump head” or “pumphead”) isn’t a medical condition itself, but rather a name given to a complex array of neurological symptoms that some patients experience after coronary artery bypass (CABG) surgery.  It is a form of postoperative cognitive dysfunction (POCD) (1).

The traditional approach of a CABG surgery requires splitting the breastbone, stopping the heart, and using a cardiopulmonary bypass (CPB) pump (or “heart-lung machine) to oxygenate and circulate blood (2). The syndrome is often called “pump head” because of the presumption that the symptoms were related to the use of the pump. It is also sometimes called “bypass brain.”

Postperfusion syndrome is a type of cognitive dysfunction involving:

  • memory problems
  • lack of mental clarity
  • poor concentration
  • inability to focus
  • impaired decision-making ability

Behavioral or emotional symptoms may include: 

  • irritability and impatience
  • flattened or heightened emotions or reactions
  • increased aggressiveness
  • reduced tolerance to stress

Some people affected by postperfusion syndrome also report:

  • changes in vision
  • disorders of smell and taste
  • balance problems

Depending on the severity of postperfusion syndrome, it can interfere with work or school and activities of daily living, especially those activities that require problem-solving and decision making. 

How Common Is Pump Head?

Postperfusion syndrome is controversial and under-recognized by the medical community.

Just how common it is and how long the symptoms last has never been entirely clear due to the lack of large, randomized trials comparing long-term changes in memory and thinking skills among people undergoing bypass surgery.

The incidence of pump head varies widely but may be as high as 50 % to 70 % at 1 week after surgery, declining to 30 % to 50 % after 2 months (3).

Many of the cognitive changes appear to be temporary, however cognitive dysfunction at 5 years after surgery has been noted in up to 40 % of patients (4).

Patients who experience long-lasting cognitive dysfunction often fear that their symptoms are permanent.

Is Pump Head a Form of Brain Damage?

Yes – but clinicians and researchers prefer to use the term “brain injury.”

A more accurate way to describe pump head in this context would be that it is a type of “acquired brain injury (ABI).”

Acquired Brain Injury (ABI) is an injury to the brain that occurs at the cellular level. It is not hereditary, congenital, degenerative, or induced by birth trauma (5).

Cognitive dysfunction is actually the most common clinical manifestation of brain injury after cardiac surgery (6).

Cardiac surgery has had the spotlight because of the higher reported incidence of postoperative cognitive dysfunction in research reports, but such symptoms may occur after other surgical procedures as well (1).

There remain many unanswered questions: what causes pump head, who is susceptible, is it reversible, and how does it relate to other neurodegenerative conditions?

What Causes Pump Head?

Although the phenomenon is not fully understood, there is considerable evidence that pump head is related to a combination of three factors often associated with the cardiopulmonary bypass (CPB) pump:  (micro)embolism,  hypoperfusion, and the systemic inflammatory response (6).

  1. (Micro)embolism: A microembolism is a small particle that becomes caught while traveling through the bloodstream and can cause blockage in a blood vessel. Microemboli can take the form of small blood clots, plaque particles, and tiny gas bubbles. During bypass surgery, tiny gas bubbles (“microbubbles”) can enter the cardiopulmonary bypass circuit from sites at the surgical field and be subsequently infused into a patient’s arterial circulation through the outflow of the cardiopulmonary bypass (CPB) circuit (7)(8)(9). These microbubbles can cause injury to the brain by disrupting blood flow. Of note, numerous studies have shown that CPB systems are not capable of completely removing microbubbles (10)(11). Additionally, cross clamping -which is done to close the aorta during surgery – can make plaque break off into the blood stream and shower the brain with microemboli (12).
  2. Hypoperfusion and Ischemia:  The cardiopulmonary bypass (CPB) machine pumps blood differently from the way the heart normally pumps blood. This results in small alternations in blood flow (“microcirculatory” alterations) and reduced organ perfusion which results in ischemia. Essentially, this means that the normal supply of blood flow to the brain required to meet metabolic demands is disrupted. Other factors that result in blood flow changes are a combination of the surgery itself, hypothermia, the anesthesia from the procedure, and the microemboli formation that occurs (13)(14).
  3. Inflammation: Significant inflammation in the body occurs during and after surgery, which can damage brain tissues and disrupt blood flow. One mechanism of inflammation involves direct “contact activation” of the immune system following exposure of blood to the foreign surfaces of the CPB circuit. A second mechanism involves ischemia–reperfusion injury to the brain, heart, lungs, kidney and liver as a result of aortic cross-clamping (15).

How to Treat Pump Head

If there’s a problem with your cognition, the very first thing you should do is talk to your doctor.

Postperfusion syndrome might not be the only explanation for your cognitive dysfunction. Your doctor will be able to sort out the root cause of your problem and help you find ways to alleviate it.

Even if your doctor determines that your cognitive problems are due to postperfusion syndrome, you can take steps to minimize the impact in your daily life.

There are important lifestyle changes you can make today that may ease your symptoms and improve your memory overall.

Here are 5 things you can do now to boost your brain power:

1. Get enough sleep

Sleep is important for various aspects of brain function. This includes cognition, concentration, productivity and performance (16).

All of these are negatively affected by sleep deprivation.

What you can do:

  • Try to get 8 hours of quality sleep per night.
  • Skip stimulants like caffeine and nicotine before bed. Alcohol may also disrupt your sleep.
  • Try to sleep and wake at consistent times. Your body’s circadian rhythm functions on a set loop, aligning itself with sunrise and sunset.
  • Optimize your bedroom.  Don’t sleep with the television on. Avoid trying to sleep with bright lights on.
  • Work on relaxation. Stress can make sleeping well difficult. Try deep breathing, yoga, meditation, or prayer.

2. Exercise your mind

Your brain needs regular workouts as you age.

What you can do:

  • Try doing brain teasers, crossword puzzles, and other mentally stimulating activities. Chess, checkers, and card games are good choices too. Games that require strategic thinking help keep your brain active and blood flowing.
  • Try starting a new hobby, like playing the piano or another type of instrument that interests you.
  • Getting out socially, spending time with friends, and conversing with people helps as well.

3. Eat a well-balanced diet

As you know, a diet that’s high in low-density lipoprotein (LDL) cholesterol and fat may be bad for both your heart and your brain.

Instead, try filling up on whole foods and healthy fats.

A previous article that I wrote lists 6 healthy foods that will boost your brain and support your overall health.

Good food choices include:

  • fresh fruits and vegetables
  • high antioxidant foods
  • fatty fish
  • beans and nuts
  • olive oil

Foods to avoid include:

  • Red meat: Aim for no more than three servings each week. This includes all beef, pork, lamb and products made from meats.
  • Fried food: At all costs, avoid fried food, especially the kind from fast-food restaurants. Limit your consumption to less than once per week.
  • Pastries and sweets: This includes most of the processed junk food and desserts you can think of. Ice cream, cookies, brownies, snack cakes, donuts, candy and more…Try to limit these to no more than four times a week.

4. Incorporate dietary supplements

Nootropics are natural supplements or drugs that have a beneficial effect on brain function.

Nootropics may also reduce age-related declines in brain function.

The scientific community is starting to recognize that dietary supplements can play an important role in supporting brain health, but more research needs to be conducted before evidence is conclusive.

Below are three supplements that may be worth adding to your daily regimen:

Prolimbic 29®

Prolimbic 29 is a physician-formulated combination of six natural ingredients to help support healthy cognitive function and brain processes associated with memory and mental energy*.

In addition to other important ingredients, Prolimbic 29® contains a patented, clinically-studied ingredient called NeuroFactor™. Derived from whole coffee fruit, NeuroFactor™ has been shown in two human clinical studies to raise BDNF levels up to 143%*. BDNF stands for brain-derived neurotrophic factor, and is a protein responsible for the development and protection of nerve cells in the central and peripheral nervous system.

Prolimbic 29® is safe for daily use by adults of all ages, without the risk of dependency or adverse side effects commonly associated with stimulants*.

The dosing is convenient -only one capsule per day – and people generally report a mental boost within the first day of taking the supplement.

To learn more about Prolimbic 29®, please click here.

Bacopa monnieri ***

Bacopa monnieri (or “bacopa”) has been shown to improve memory and thinking skills in healthy people and in those with a decline in brain function.

“Bacopa” is a medicine made from the herb Bacopa monnieri. It’s used in traditional medicine practices like Ayurveda for improving brain function.

It’s been shown to improve thinking skills and memory, both in healthy people and in elderly people suffering from a decline in brain function (17181920, 21).

People generally take about 300 mg per day and it may take around four to six weeks for you to notice any results.

Phosphatidylserine

Phosphatidylserine is a type of fat compound called a phospholipid, which can be found in your brain (23).

It’s been suggested that taking phosphatidylserine supplements could be helpful for preserving brain health (24).

Studies have shown that taking 100 mg of phosphatidylserine three times per day could help reduce age-related decline in brain function (25262728).

However, larger studies need to be carried out before its effects on brain function can be fully understood.

5. Use Memory Aids, Tips, and Tricks

Try arming yourself with tools and habits that will make navigating your day easier.

For example:

  • Lists: Free up your mind so you don’t have to remember crucial tasks.
  • Sticky notes: Strategically place them to jog your memory when you need it.
  • Kitchen timer: Stay on task and on schedule.
  • Calendar: Mark down important events and refer to it often.
  • Break routine: Switching habits like wearing your watch on the wrong hand can trigger memory recall.

What is the Outlook?

Cognitive impairment after bypass surgery is a significant worry for patients and their loved ones.

Each person has a unique health history and is affected differently by their symptoms.

Some people have significant struggles with their cognitive symptoms.

Luckily, most people report that their symptoms are manageable.

It’s helpful, however, to know the facts about pump head and how lifestyle changes can ease your symptoms and improve your memory overall.

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