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Published on: June 12, 2021
Postcardioplegia ventricular fibrillation: no impact on subsequent survival
Sven Martin Almdahl1, Terje Veel, Magne Eide
1Department of Cardiac Surgery, Feiring Heart Clinic , Feiring , Norway.
Insights
Post-cardiac arrest, initial rhythm (ventricular fibrillation or non-VF) and potassium treatment for VF did not impact long-term survival. Electrical conversion after failed potassium treatment showed a trend toward increased mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Initial rhythm after aortic declamping in cardiac surgery can be ventricular fibrillation (VF) or non-VF.
- Ventricular fibrillation (VF) is typically managed with potassium-induced conversion, with direct-current countershock reserved for treatment failures.
Purpose of the Study:
- To investigate differences in patient outcomes based on initial rhythm and VF treatment post-cardioplegic arrest.
- To determine the association between postcardioplegia VF, potassium treatment, and long-term all-cause mortality.
Main Methods:
- Retrospective analysis of 12,113 cardiac surgery patients (1999-2010).
- Survival data obtained from the Norwegian National Registry.
- Cox multivariable modeling adjusted for baseline clinical, biochemical, and medication data.
Main Results:
- No significant difference in adjusted survival between patients with no postcardioplegia VF and those with successful potassium-induced conversion.
- Patients requiring electrical conversion after failed potassium treatment demonstrated a non-significant trend towards increased mortality (HR 1.19, 95% CI 0.99-1.4).
- Overall all-cause mortality was 24.9% over a mean follow-up of 7.4 years.
Conclusions:
- This study is the first to report on postcardioplegia VF, potassium treatment, and patient outcomes.
- No impact of postcardioplegia VF or its potassium-based treatment on all-cause mortality was observed.
Objectives:
At aortic declamping after cardioplegic cardiac arrest, the initial rhythm can be broadly classified as ventricular fibrillation (VF) or non-VF. VF can be treated with potassium-induced conversion and direct-current countershock is only applied if potassium treatment fails. We aimed to investigate whether there are any differences between these groups of patients in regard to outcomes.
Design:
From January 1999 through December 2010, 12,113 patients underwent various types of cardiac surgery. Data from every patient were consecutively registered. Survival was established through the Norwegian National Registry. Cox multivariable modeling with adjustment for clinical, biochemical, and medication baseline data was used for survival analysis.
Results:
The mean follow-up time was 7.4 years and total patient-years were 89,268. The percentage of all-cause deaths was 24.9. Adjusted survival for patients with no postcardioplegia VF (n = 9723) and patients with successful potassium-induced conversion (n = 1877) was completely identical. Four hundred patients with electrical conversion after failed potassium treatment had a nonsignificant trend toward an increased mortality (hazard ratio, 95% confidence interval: 1.19 (0.99-1.4); p = 0.07).
Conclusions:
This is the first study reporting the association between postcardioplegia VF, its treatment with potassium and outcome. No impact was found on outcome as judged by all-cause mortality.
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