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Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a
Qing Miao1, Dong Jin Wu1, Xu Chen1
1Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.
Insights
Maintaining a higher mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) in cardiac surgery patients significantly reduced blood lactate levels. This approach also decreased epinephrine use and shortened intensive care unit stays.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Hyperlactatemia is a known predictor of poor outcomes in patients undergoing cardiac surgery.
- Understanding factors influencing lactate levels, such as blood pressure management during cardiopulmonary bypass (CPB), is crucial for improving patient prognosis.
Purpose of the Study:
- To investigate the effect of different target mean arterial pressure (MAP) strategies during CPB on postoperative blood lactate levels.
- To evaluate secondary outcomes including vasopressor use, extubation time, and intensive care unit (ICU) length of stay.
Main Methods:
- A randomized controlled trial (RCT) involving 40 adult patients undergoing cardiac valve surgery.
- Patients were assigned to either a low MAP group (50–60 mmHg) or a high MAP group (70–80 mmHg) during CPB.
- Blood lactate levels were measured at multiple time points, and secondary outcomes were recorded.
Main Results:
- The high MAP group exhibited significantly lower blood lactate levels at the end of the operation (T2), end of CPB (T1), and 1 hour postoperatively (T3) compared to the low MAP group.
- Patients in the low MAP group required significantly more epinephrine and had longer extubation times and ICU stays.
Conclusions:
- Targeting a higher MAP during CPB in cardiac surgery patients effectively reduces postoperative hyperlactatemia.
- This strategy is associated with decreased vasopressor requirements and improved early recovery metrics, such as shorter ICU length of stay and earlier extubation.
Background:
Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery.
Methods:
Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year.
Results:
Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group.
Conclusions:
Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery.
Trial Registration:
This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941 . It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.
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