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Novel thermoregulation system for enhancing cardiac function and hemodynamics during coronary artery bypass graft
1Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. nnesher@netvision.net.il
Insights
A novel thermoregulation system effectively maintained normothermia during coronary artery bypass graft (CABG) surgery. This improved cardiac index and reduced myocardial injury markers compared to routine care.
Area of Science:
- Cardiology
- Anesthesiology
- Medical Devices
Background:
- Postoperative hypothermia is linked to myocardial ischemia, arrhythmias, and coagulopathies.
- Coronary artery bypass graft (CABG) surgery presents risks associated with temperature fluctuations.
- Assessing novel thermoregulation systems is crucial for improving patient outcomes in cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of a novel Allon thermoregulation (AT) system in maintaining normothermia during CABG surgery.
- To compare the AT system's performance against routine thermal care (RTC) in preventing adverse postoperative events.
- To assess the impact of the AT system on hemodynamic parameters and myocardial injury markers.
Main Methods:
- Randomized controlled trial comparing AT (n=40) with RTC (n=20) in elective CABG patients.
- AT system utilized a garment with circulating water at 37°C, guided by rectal temperature monitoring.
- Key assessments included rectal temperature, cardiac index (CI), systemic vascular resistance (SVR), and cardiac-specific troponin I (cTnI) levels at multiple intraoperative and postoperative time points.
Main Results:
- Patients in the AT group maintained significantly higher body temperatures throughout the study compared to the RTC group.
- The AT group exhibited a higher cardiac index (CI) and lower systemic vascular resistance (SVR) compared to the RTC group.
- Elevated enzyme levels (cTnI) were observed in both groups, but were notably lower in the AT group, suggesting reduced myocardial injury.
Conclusions:
- The Allon thermoregulation system effectively maintains normothermia during CABG surgery.
- The AT system demonstrates beneficial hemodynamic effects, including elevated CI and reduced SVR.
- Lower cTnI levels in the AT group indicate a potential attenuation of myocardial injury, improving surgical outcomes.
Background:
Myocardial ischemia, arrhythmias, and coagulopathies are associated with postoperative hypothermia. This study assessed the efficacy of a novel thermoregulation system in alleviating these events during coronary artery bypass graft (CABG) surgery.
Methods:
Elective CABG surgery patients were randomized into either Allon thermoregulation (AT, n = 40) or routine thermal care (RTC, n = 20) groups in whom the maintenance of normothermia during the nonbypass phases of the operation was compared. The AT used patients' rectal temperature as reference data to monitor the maintenance of the water temperature circulating at 37 degrees C in a garment. Rectal temperature, patient hemodynamics, and cardiac-specific troponin I (cTnI) levels were assessed at the induction of anesthesia, 30 minutes into surgery, at discontinuation of bypass, end of surgery, and 2 hours postoperatively.
Results:
Body temperature was higher in the AT group compared to the RTC group at all five time points. Cardiac index (CI) (L/min) was higher in the AT group, 2.5 +/- 0.5, 2.6 +/- 0.5*, 3.2 +/- 0.6*, 3.3 +/- 0.5*, 3.1 +/- 0.7 at the respective time points, compared to the RTC group, 2.3 +/- 0.6, 2.1 +/- 0.2, 2.6 +/- 0.7, 2.7 +/- 0.7, 2.7 +/- 0.7 (*p < 0.05). Systemic vascular resistance (SVR) (dyne x s)/cm5) was consistently lower in the AT patients. Enzyme levels were elevated in both groups but were less so in the AT patients.
Conclusions:
The AT system can efficiently maintain normothermia. The beneficial effects are expressed by reduced SVR, elevated CI, and lower levels of cTnI, which may show a possible attenuation of myocardial injury.