Cardiopulmonary bypass time: every minute counts

Autor: Sudharsan Madhavan, Bowen Li, Leok-Kheng Kristine Teoh, Jolane Eng, Siew Pang Chan, Wei-Chuan Tan, Hai-Dong Luo
Rok vydání: 2018
Předmět:
Male
Time Factors
Adverse outcomes
Cardiopulmonary bypass time
medicine.medical_treatment
Operative Time
Coronary Artery Disease
030204 cardiovascular system & hematology
Risk Assessment
Decision Support Techniques
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Euroscore ii
Risk Factors
law
medicine
Cardiopulmonary bypass
Humans
Icu stay
Coronary Artery Bypass
Aged
Mechanical ventilation
Cardiopulmonary Bypass
business.industry
Clinical events
Decision Trees
Direct effects
General Medicine
Length of Stay
Middle Aged
Respiration
Artificial
Intensive Care Units
Treatment Outcome
surgical procedures
operative
030228 respiratory system
Anesthesia
Female
Surgery
Cardiology and Cardiovascular Medicine
business
circulatory and respiratory physiology
Zdroj: The Journal of Cardiovascular Surgery. 59
ISSN: 1827-191X
0021-9509
Popis: Background This study was conducted to examine the impact of CPB times on postoperative outcomes. We sought to determine the optimum cut-offs of CPB per graft time and cumulative CPB time and their predictive accuracy for mortality in conjunction with EuroSCORE II. Methods The de-identified data of 1960 patients who had undergone isolated on-pump CABG from 2009 to 2014 were analyzed. The risk strata of cardiopulmonary bypass (CPB)/graft and cumulative CPB times, identified with a decision tree, were added into an augmented model for predicting short- and intermediate-term postoperative clinical events. Results Prolonged cumulative CPB time (>180 minutes) was significant in predicting mortality while adjusting for EuroSCORE II, postoperative complications, prolonged ICU stay and prolonged mechanical ventilation. Whereas prolonged CPB/graft time (>56 minutes) was marginally non-significant in terms of its direct effects, its indirect effect on mortality could be manifested through enhanced risks of complications, prolonged ICU stay (>48 hours) and prolonged mechanical ventilation (>24 hours). Conclusions Prolonged CPB times could predict postoperative clinical events, in particular mortality. To minimize the occurrence of unfavorable adverse outcomes, it is recommended that the CPB/graft time and cumulative CPB time be kept below 56 minutes and 180 minutes respectively.
Databáze: OpenAIRE
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