Esmolol in Cardiac Surgery: A Randomized Controlled Trial
| Autor: | Rosalba Lembo, Margherita Licheri, Elena Bignami, Evgeny Fominskiy, Chiara Gerli, Giuseppe Crescenzi, Beatrice Noè, Martina Crivellari, Nora Di Tomasso, Alessandro Oriani, Ambra Licia Di Prima, Fabrizio Monaco, Giovanni Landoni, Alberto Zangrillo, Pasquale Nardelli |
|---|---|
| Přispěvatelé: | Zangrillo, A., Bignami, E., Noe, B., Nardelli, P., Licheri, M., Gerli, C., Crivellari, M., Oriani, A., Di Prima, A. L., Fominskiy, E., Di Tomasso, N., Lembo, R., Landoni, G., Crescenzi, G., Monaco, F. |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
esmolol 030204 cardiovascular system & hematology Placebo Ventricular Function Left law.invention Propanolamines 03 medical and health sciences 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Interquartile range medicine Humans Cardiac Surgical Procedures Ejection fraction business.industry Stroke Volume Esmolol Intensive care unit Cardiac surgery Anesthesiology and Pain Medicine Anesthesia β-blockers Bolus (digestion) Cardiology and Cardiovascular Medicine business cardiopulmonary bypass cardiac surgery medicine.drug |
| Popis: | Objective To assess whether the administration of the ultra-short–acting β-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes. Design Single-center, double-blinded, parallel-group randomized controlled trial. Setting A tertiary care referral center. Participants Patients undergoing elective cardiac surgery with preoperative evidence of left ventricular end-diastolic diameter >60 mm and/or left ventricular ejection fraction Interventions Patients were assigned randomly to receive either esmolol (1 mg/kg as a bolus before aortic cross-clamping and 2 mg/kg mixed in the cardioplegia solution) or placebo in a 1:1 allocation ratio. Measurements and Main Results The primary composite endpoint of prolonged intensive care unit stay and/or in-hospital mortality occurred in 36/98 patients (36%) in the placebo group versus 27/102 patients (27%) in the esmolol group (p = 0.13). In the esmolol group, a reduction in the maximum inotropic score during the first 24 postoperative hours was observed (10 [interquartile range 5-15] v 7 [interquartile range 5-10.5]; p = 0.04), as well as a trend toward a reduction in postoperative low-cardiac-output syndrome (13/98 v 6/102; p = 0.08) and the rate of hospital admission at one year (26/95 v 16/96; p = 0.08). A trend toward an increase in the number of patients with ejection fraction ≥60% at hospital discharge also was observed (4/95 v 11/92; p = 0.06). Conclusions In the present trial, esmolol as a cardioplegia adjuvant enhanced postoperative cardiac performance but did not reduce a composite endpoint of prolonged intensive care unit stay and/or mortality. |
| Databáze: | OpenAIRE |
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