虚血性心筋症のプロトコル駆動型周術期管理をコミュニティ病院で実施

We describe our experience using a defined protocol for the selection, classification, and treatment of patients with ischemic cardiomyopathy (ICM) undergoing coronary artery bypass grafting (CABG), with or without additional procedures, in a nonacademic setting with expected limited resources and support staff.

From December 2021 to December 2023, 25 patients with an ejection fraction of ≤0.44 due to ICM requiring CABG were assigned to a treatment algorithm based on the preoperative classification for CABG with no device (n = 9), balloon pump (n = 2), or direct centrifugal pump (n = 14) placed in the operating room.

Preliminary data of all patients with surgically revascularized ICM using the defined protocol demonstrated a predicted average risk of mortality of 8.455% vs our mortality rate of 4%, whereas the average predicted risk of morbidity and mortality was 27.7%, with our 30-day morbidity and mortality of 24%. Subgroup analysis of the 3 patient categories: moderately depressed, low risk; moderately depressed, high risk; and severely depressed; shows better-than-expected outcomes when compared with predictions.

In a community hospital setting, experience using a defined protocol to select and manage patients with ICM undergoing CABG reduced morbidity and mortality compared with predicted outcomes. This is a practical method of managing high-risk CABG patients with the expected limitations of a community hospital.