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      • Record: found
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      Efficacy of early goal-directed therapy using FloTrac/EV1000 to improve postoperative outcomes in patients undergoing off-pump coronary artery bypass surgery: a randomized controlled trial

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          Abstract

          Background

          Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in intensive care (ICU) and hospital among patients undergoing coronary artery bypass graft (CABG) with a cardiopulmonary bypass. However, this platform in off-pump CABG (OPCAB) has received scant attention, so we evaluated the efficacy of EGDT using FloTrac/EV1000 as a modality for improving postoperative outcomes in patients undergoing OPCAB.

          Methods

          Forty patients undergoing OPCAB were randomized to the EV1000 or Control group. The Control group received fluid, inotropic, or vasoactive drugs (at the discretion of the attending anesthesiologist) to maintain a mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥ 0.5 mL kg −1 h −1; SpO 2 > 95%; and hematocrit ≥ 30%. The EV1000 group achieved identical targets using information from the FloTrac/EV1000. The goals included stroke volume variation < 13%; cardiac index (CI) of 2.2–4.0 L min −1 m −2; and systemic vascular resistance index of 1500–2500 dynes s −1 cm −5 m −2.

          Results

          The EV1000 group had a shorter LOS in ICU (mean difference − 1.3 d, 95% CI − 1.8 to − 0.8; P < 0.001). The ventilator time for both groups was comparable ( P = 0.316), but the hospital stay for the EV1000 group was shorter (mean difference − 1.4 d, 95% CI − 2.1 to − 0.6; P < 0.001).

          Conclusions

          EGDT using FloTrac/EV1000 compared to conventional protocol reduces LOS in ICU and hospital among patients undergoing OPCAB.

          Trial registration This study was retrospectively registered at www.ClinicalTrials.gov (NCT04292951) on 3 March 2020.

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          Most cited references27

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          Age-related iso-MAC charts for isoflurane, sevoflurane and desflurane in man.

          R Nickalls, W Mapleson (2003)
          The motivation for this study was the current difficulty in estimating the total age-related MAC for a patient in a clinical setting. Age-related iso-MAC charts for isoflurane, sevoflurane and desflurane were developed for the clinically useful MAC range (0.6-1.6), age range 5-95 yr, and put in a convenient form for use by practising anaesthetists. The charts are based on Mapleson's meta-analysis (1996) of the available MAC data and can be used to allow for the contribution of nitrous oxide to the total MAC. The charts indicate the influence of age on anaesthetic requirements, showing, for example, that a total MAC of 1.2 using isoflurane and nitrous oxide 67% in oxygen requires an end-expired isoflurane concentration of only 0.25% in a patient of 95 yr vs 1% in a 5-yr-old patient. Colleagues found the charts to be helpful and simple to use clinically. The iso-MAC charts show clearly how patient age can be used to guide the choice of end-expired agent concentration. They also allow a consistent total MAC to be maintained when changing the inspired nitrous oxide concentration, thereby reducing the chance of inadvertent awareness, particularly at the extremes of age.
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            Off-pump or on-pump coronary-artery bypass grafting at 30 days.

            Andre Lamy, P.J. Devereaux, Dorairaj Prabhakaran … (2012)
            The relative benefits and risks of performing coronary-artery bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as compared with cardiopulmonary bypass (on-pump CABG), are not clearly established. At 79 centers in 19 countries, we randomly assigned 4752 patients in whom CABG was planned to undergo the procedure off-pump or on-pump. The first coprimary outcome was a composite of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days after randomization. There was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P=0.59) or in any of its individual components. The use of off-pump CABG, as compared with on-pump CABG, significantly reduced the rates of blood-product transfusion (50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001), reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk, 0.61; 95% CI, 0.40 to 0.93; P=0.02), acute kidney injury (28.0% vs. 32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P=0.01), and respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI, 0.63 to 0.98; P=0.03) but increased the rate of early repeat revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to 12.0; P=0.01). There was no significant difference between off-pump and on-pump CABG with respect to the 30-day rate of death, myocardial infarction, stroke, or renal failure requiring dialysis. The use of off-pump CABG resulted in reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications, and acute kidney injury but also resulted in an increased risk of early revascularization. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).
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              On-pump versus off-pump coronary-artery bypass surgery.

              A Laurie Shroyer, Frederick L Grover, Brack Hattler … (2009)
              Coronary-artery bypass grafting (CABG) has traditionally been performed with the use of cardiopulmonary bypass (on-pump CABG). CABG without cardiopulmonary bypass (off-pump CABG) might reduce the number of complications related to the heart-lung machine. We randomly assigned 2203 patients scheduled for urgent or elective CABG to either on-pump or off-pump procedures. The primary short-term end point was a composite of death or complications (reoperation, new mechanical support, cardiac arrest, coma, stroke, or renal failure) before discharge or within 30 days after surgery. The primary long-term end point was a composite of death from any cause, a repeat revascularization procedure, or a nonfatal myocardial infarction within 1 year after surgery. Secondary end points included the completeness of revascularization, graft patency at 1 year, neuropsychological outcomes, and the use of major resources. There was no significant difference between off-pump and on-pump CABG in the rate of the 30-day composite outcome (7.0% and 5.6%, respectively; P=0.19). The rate of the 1-year composite outcome was higher for off-pump than for on-pump CABG (9.9% vs. 7.4%, P=0.04). The proportion of patients with fewer grafts completed than originally planned was higher with off-pump CABG than with on-pump CABG (17.8% vs. 11.1%, P<0.001). Follow-up angiograms in 1371 patients who underwent 4093 grafts revealed that the overall rate of graft patency was lower in the off-pump group than in the on-pump group (82.6% vs. 87.8%, P<0.01). There were no treatment-based differences in neuropsychological outcomes or short-term use of major resources. At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources. (ClinicalTrials.gov number, NCT00032630.). Copyright 2009 Massachusetts Medical Society.
              Article 0 comments Cited 59 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sirirat Tribuddharat: sirirat.tribuddharat@gmail.com
                Thepakorn Sathitkarnmanee: thepakorns@gmail.com
                Kriangsak Ngamsaengsirisup: kriang@kku.ac.th
                Sanpicha Sornpirom: ssanpi@kku.ac.th
                Journal
                Journal ID (nlm-ta): J Cardiothorac Surg
                Journal ID (iso-abbrev): J Cardiothorac Surg
                Title: Journal of Cardiothoracic Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1749-8090
                Publication date (Electronic): 21 August 2022
                Publication date PMC-release: 21 August 2022
                Publication date Collection: 2022
                Volume: 17
                Electronic Location Identifier: 196
                Affiliations
                [1 ]GRID grid.9786.0, ISNI 0000 0004 0470 0856, Department of Anesthesiology, Faculty of Medicine, , Khon Kaen University, ; 123 Mitrapap Road, Ampur Muang, Khon Kaen, 40002 Thailand
                [2 ]GRID grid.9786.0, ISNI 0000 0004 0470 0856, Cardiothoracic Intensive Care Unit, Faculty of Medicine, , Khon Kaen University, ; 123 Mitrapap Road, Ampur Muang, Khon Kaen, 40002 Thailand
                Article
                Publisher ID: 1933
                DOI: 10.1186/s13019-022-01933-4
                PMC ID: 9394084
                PubMed ID: 35989328
                SO-VID: 4d9f8624-ef30-483f-aea7-bca429f678dd
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 11 February 2022
                Date accepted : 14 August 2022
                Funding
                Funded by: Faculty of Medicine, Khon Kaen University
                Award ID: IN62127
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Surgery
                Keywords: early goal-directed therapy,off-pump coronary artery bypass graft,length of stay,intensive care unit,hospital
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: early goal-directed therapy, off-pump coronary artery bypass graft, length of stay, intensive care unit, hospital

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