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Published on: March 27, 2018
Predictive factors of hemodynamic collapse after coronary artery bypass grafting: a case-control study
Janne P Karhunen1, Eero I T Sihvo, Raili T Suojaranta-Ylinen
1Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland. Janne.Karhunen@helsinki.fi
Insights
Sudden hemodynamic collapse after coronary artery bypass graft surgery is a serious complication. Key predictors include inadequate tissue perfusion, postoperative myocardial ischemia, and increased need for inotropic and mechanical support.
Area of Science:
- Cardiothoracic Surgery
- Cardiovascular Research
- Critical Care Medicine
Background:
- Sudden hemodynamic collapse post-coronary artery bypass graft (CABG) surgery is a rare but severe complication.
- This complication is associated with high morbidity and mortality rates.
Purpose of the Study:
- To identify pre-, intra-, and postoperative factors predictive of sudden hemodynamic collapse after CABG.
- To understand the clinical characteristics and outcomes of patients experiencing this complication.
Main Methods:
- Retrospective case-control study involving 76 patients who experienced hemodynamic collapse (OCM group) and 76 matched controls.
- Analysis included pre-, intra-, and postoperative variables, with significant factors tested using regression techniques.
Main Results:
- Hemodynamic collapse occurred in 0.9% of 8,807 CABG patients, predominantly within the first 5 postoperative hours.
- The OCM group had significantly prolonged cardiopulmonary bypass time, lower cardiac index, and lower pH/BE values post-CPB.
- Postoperative myocardial ischemia was more frequent in the OCM group (33% vs. 8%), requiring more inotropic and mechanical support.
Conclusions:
- Inadequate tissue perfusion, postoperative myocardial ischemia, and increased need for circulatory support are significant predictors of hemodynamic collapse post-CABG.
- Interventions aimed at improving tissue perfusion and managing myocardial ischemia may improve outcomes for patients at risk.
Objective:
Sudden hemodynamic collapse after coronary artery bypass graft (CABG) surgery is a complication with high morbidity and mortality. The aim of this study was to explore factors possibly predictive of this major complication.
Design:
Retrospective case-control study.
Setting:
University hospital, department of cardiothoracic surgery.
Participants:
Between 1988 and 1999, of 8,807 CABG patients, a total of 76 (0.9%) suffered hemodynamic collapse after CABG surgery unrelated to pericardial tamponade or bleeding. Preoperatively matched patients (by age, sex, New York Heart Association classification, number of diseased vessels, left ventricular ejection fraction, and diabetes) served as a control group (n = 76).
Interventions:
Patients with sudden cardiovascular collapse underwent emergency reopening of the sternotomy and open cardiac massage (OCM group). Several pre-, intra-, and postoperative variables were compared, and significant parameters in match-pair analysis were further tested with regression techniques.
Measurements And Main Results:
Of the 76 OCMs, 57 (75%) occurred during the first 5 postoperative hours. In-hospital mortality was 46% (35 of 76) versus 0% in controls; 5-year survival was 49% versus 95%. In the OCM group, cardiopulmonary bypass (CPB) time was significantly prolonged (p = 0.0024), and cardiac index (p = 0.05) and the first acid-base values after CPB were lower (pH, p = 0.0057; BE, p = 0.0014). Postoperative myocardial ischemia appeared in 33% of patients in the OCM group and in 8% of controls (p < 0.0001). OCM-group patients more frequently required postoperative inotropic (epinephrine, p = 0.0002) and mechanical support (intra-aortic balloon pump, p = 0.005). Regression analysis revealed a correlation between cardiopulmonary resuscitation risk and low cardiac index, postoperative ischemia, and low pH level.
Conclusion:
Inadequate tissue perfusion, postoperative myocardial ischemia, and increased need for inotropic and mechanical support preceded hemodynamic collapse. Interventions to improve tissue perfusion and to prevent and treat myocardial ischemia may result in a more favorable outcome.