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Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits
Jeysen Zivan Yogaratnam1, Gerard Laden, Levant Guvendik
1Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, HU16 JQ Cottingham, United Kingdom. jeysenzy@msn.com
Insights
Hyperbaric oxygen (HBO2) preconditioning improves left ventricular stroke work (LVSW) in coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) surgery. This treatment also reduces myocardial injury, blood loss, and intensive care unit (ICU) stay.
Area of Science:
- Cardiovascular Surgery
- Hyperbaric Medicine
- Critical Care
Background:
- Coronary artery disease (CAD) patients undergoing on-pump cardiopulmonary bypass (CPB) coronary artery bypass graft (CABG) surgery face risks of myocardial injury and prolonged recovery.
- Preconditioning strategies are explored to mitigate surgical stress and improve outcomes in high-risk cardiac patients.
Purpose of the Study:
- To determine if hyperbaric oxygen (HBO2) preconditioning improves myocardial left ventricular stroke work (LVSW) 24 hours post-CABG in CAD patients.
- To evaluate the effect of HBO2 preconditioning on perioperative clinical outcomes and costs.
Main Methods:
- A randomized controlled study involving 81 patients undergoing on-pump CPB CABG.
- The HBO2 group (n=41) received preconditioning with 100% oxygen at 2.4 ATA for two 30-minute intervals.
- Hemodynamic measurements, troponin T levels, and clinical outcomes were monitored perioperatively.
Main Results:
- The HBO2 group demonstrated significantly improved LVSW (P=.005) and stroke volume (P=.01) post-CPB.
- HBO2 preconditioning led to reduced troponin T levels, indicating less myocardial injury.
- Significant reductions were observed in intraoperative blood loss (57%), ICU length of stay (18%), and various postoperative complications, alongside cost savings.
Conclusions:
- HBO2 preconditioning successfully improved LVSW in CAD patients undergoing CABG, meeting the primary study endpoint.
- HBO2 preconditioning offers a promising strategy to reduce myocardial injury, perioperative complications, and healthcare costs associated with CABG surgery.
Objective:
The objective of this study was to determine whether preconditioning coronary artery disease (CAD) patients with HBO(2) prior to first-time elective on-pump cardiopulmonary bypass (CPB) coronary artery bypass graft surgery (CABG) leads to improved myocardial left ventricular stroke work (LVSW) post CABG. The primary end point of this study was to demonstrate that preconditioning CAD patients with HBO(2) prior to on-pump CPB CABG leads to a statistically significant (P<.05) improvement in myocardial LVSW 24 h post CABG.
Methods:
This randomised control study consisted of 81 (control group=40; HBO(2) group=41) patients who had CABG using CPB. Only the HBO(2) group received HBO(2) preconditioning for two 30-min intervals separated 5 min apart. HBO(2) treatment consisted of 100% oxygen at 2.4 ATA. Pulmonary artery catheters were used to obtain perioperative hemodynamic measurements. All routine perioperative clinical outcomes were recorded. Venous blood was taken pre HBO(2), post HBO(2) (HBO(2) group only), and during the perioperative period for analysis of troponin T.
Results:
Prior to CPB, the HBO(2) group had significantly lower pulmonary vascular resistance (P=.03). Post CPB, the HBO(2) group had increased stroke volume (P=.01) and LVSW (P=.005). Following CABG, there was a smaller rise in troponin T in HBO(2) group suggesting that HBO(2) preconditioning prior to CABG leads to less postoperative myocardial injury. Post CABG, patients in the HBO(2) group had an 18% (P=.05) reduction in length of stay in the intensive care unit (ICU). Intraoperatively, the HBO(2) group had a 57% reduction in intraoperative blood loss (P=.02). Postoperatively, the HBO(2) group had a reduction in blood loss (11.6%), blood transfusion (34%), low cardiac output syndrome (10.4%), inotrope use (8%), atrial fibrillation (11%), pulmonary complications (12.7%), and wound infections (7.6%). Patients in the HBO(2) group saved US$116.49 per ICU hour.
Conclusion:
This study met its primary end point and demonstrated that preconditioning CAD patients with HBO(2) prior to on-pump CPB CABG was capable of improving LVSW. Additionally, this study also showed that HBO(2) preconditioning prior to CABG reduced myocardial injury, intraoperative blood loss, ICU length of stay, postoperative complications, and saved on cost, post CABG.
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