[Early activation of patients after myocardial revascularization under prolonged extracorporeal circulation]

The purpose of the study was to analyze the experience with fast-track activation of patients after myocardial revascularization with cardiopulmonary bypass (CPB) longer than 150 min and to study the efficiency of these procedures. The study included 64 ischemic patients (56 males and 8 females) aged 58.7+/-1 years, surged with CPB. In all cases, surgery and CPB were uncomplicated. The time of CPB was 151-298 (187+/-4) min; that of aortic cross-clamping was 67-181 (121+/-4) min. Hemodynamics, pulmonary gas exchange, and laboratory parameters were virtually normal before activation. Tracheal extubation was performed in the operating room 27-117 (61+/-3) min following the end procedure. The length of intensive care unit (ICU) stay was less than 24 hours in 82.8% of patients. The remaining patients stayed at an ICU 2-15 (2+/-1) days, which was associated with cardiac, pulmonary, renal complications, etc. The doses of dopamine and/or dobutamine and norepinephrine, and the index PO2a/FiO2 were shown to be predictors of ICU stay. It is concluded that fast-track activation is appropriate for patients undergoing prolonged CPB. The patients enrolled in the fast-track programme after prolonged CPB are to meet the following requirements: minimum inotropic and vasopressor support and PO2a/FiO2 greater than 350 mm Hg.