Related Experiment Videos
Lowest core body temperature and adverse outcomes associated with coronary artery bypass surgery
Gordon R DeFoe1, Charles F Krumholz, Christian P DioDato
1Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Gordon.DeFoe@hitchcock.org
Insights
Lowering core body temperature during coronary artery bypass graft (CABG) surgery, particularly during cardiopulmonary bypass (CPB), is linked to increased in-hospital mortality. Maintaining a higher core body temperature may improve patient outcomes in CABG procedures.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Core body temperature management during cardiopulmonary bypass (CPB) is a critical factor in cardiac surgery.
- Previous research suggests a link between hypothermia and adverse outcomes, but specific temperature thresholds and their impact on mortality and morbidity require further investigation.
Purpose of the Study:
- To investigate the association between the lowest intraoperative core body temperature and adverse outcomes in patients undergoing isolated coronary artery bypass graft (CABG) surgery.
- To determine if temperature management strategies during CABG impact patient mortality and other perioperative complications.
Main Methods:
- Analysis of data from 7134 isolated CABG procedures performed between 1997 and 2000.
- Exclusion of patients with specific CPB times or continuous warm cardioplegia.
- Categorization of lowest core body temperature into quartiles for statistical analysis.
Main Results:
- A statistically significant trend of higher in-hospital mortality rates with decreasing core body temperature was observed (P(trend) < 0.001).
- Mortality rates ranged from 2.9% in the coldest group (< 31.4°C) to 1.2% in the warmest group (≥ 34.4°C).
- A marginal but significant trend towards lower perioperative stroke rates was noted in colder groups (p = 0.044), and increased use of intra-aortic balloon pumps in colder patients.
Conclusions:
- Low core body temperatures during CPB are significantly associated with increased in-hospital mortality in isolated CABG patients.
- Temperature management during CABG surgery plays a crucial role in influencing patient outcomes, including mortality and the need for perioperative interventions.
- Optimizing intraoperative temperature may be a key strategy to improve safety and reduce adverse events in CABG surgery.
Abstract:
To examine the effect of lowest core body temperature on adverse outcomes associated with coronary artery bypass graft (CABG) surgery, data were collected on 7134 isolated CABG procedures carried out in New England from 1997 to 2000. Excluded from the analysis were patients with pump times < 60 and > 120 min and those operated upon using continuous warm cardioplegia. Data for lowest core temperature were divided into quartiles for analysis ( < 31.4 degrees C, 31.5-33.1 degrees C, 33.2-34.3 degrees C, and 2 34.4 degrees C). Patients with lower core body temperature on cardiopulmonary bypass (CPB) had higher in-hospital mortality rates. Crude mortality rates were 2.9% in the < or = 31.4 degrees C group, 2.1% in the 31.5-33.1 degrees C group, 1.3% in the 33.2-34.3 degrees C group and 1.2% in the > or = 34.4 degrees C group. The trend toward higher mortality as core temperature decreased was statistically significant (P(trend) < 0.001). Adjustment for differences in patient and disease characteristics did not significantly change the results and the test of trend remained significant (p < 0.001). Rates of perioperative stroke were somewhat lower in the colder groups. Rates in the two colder groups were 0.9% compared with 1.6% and 1.4% in the warmer groups (P(trend) = 0.082). This remained a marginal but significant trend after adjustment for possible confounding factors (p = 0.044). Low core body temperatures on CPB are associated with higher rates of in-hospital mortality among isolated CABG patients. Rates of intra- or postoperative use of an intra-aortic balloon pump are also higher with lower core temperatures. We concluded that temperature management strategy during CABG surgery has an important effect on patient outcomes.