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Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency
Jowita Bruno1, Mascha Varayath2, Brigitta Gahl3
1Intensive Care Unit, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Insights
Reoperation for bleeding after emergency coronary artery bypass grafting is a mortality risk. While fluid intake and balance influenced reoperation, altered fluid resuscitation strategies did not change its incidence in this study.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Anesthesiology
Background:
- Reoperation for bleeding (ROB) following emergency coronary artery bypass grafting (eCABG) is a significant risk factor for mortality.
- Postoperative fluid management is crucial in cardiac surgery patients.
Purpose of the Study:
- To analyze the influence of fluid intake, output, balance, blood loss, and inotropic demand on ROB after eCABG.
- To evaluate the impact of a modified fluid resuscitation strategy (lower volume, higher vasoactive support) on ROB incidence.
Main Methods:
- Retrospective single-center study of 265 patients undergoing eCABG (2011-2020).
- Comparison of ROB incidence before and after implementation of a new hemodynamic management protocol in 2018.
- Analysis of perioperative risk factors including EuroSCORE II, fluid balance, and norepinephrine administration.
Main Results:
- The incidence of ROB was not significantly different between the pre- and post-protocol groups (P=.3).
- Higher perioperative risk (EuroSCORE II), increased fluid intake (P=.021), positive fluid balance (P=.001), and norepinephrine administration (P=.004) were associated with ROB.
- Fluid output and blood loss were not associated with ROB (P=.22).
Conclusions:
- Altered fluid resuscitation protocols did not impact the incidence of reoperation for bleeding after emergency CABG.
- Fluid intake, fluid balance, and inotropic support remain associated with ROB, suggesting their importance in patient management.
Abstract:
Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.
Trial Registration:
www.
Clinicaltrials:
gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.
Clinicaltrials:
gov/ct2/show/NCT04533698.
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