Hypothermic Cardiopulmonary Bypass in CABG surgery, it is the time to revise our protocols
Main Article Content
Abstract
Background: Hypothermia during coronary artery bypass grafting (CABG) procedures using cardiopulmonary bypass (CPB) technique is a defensive maneuver. Since most surgeons worldwide are accustomed to the use of "mild" hypothermia for such procedures, this study hope to discover whether "moderate" hypothermia had a more significant impact on lowering tissue oxygen consumption during cardiac surgery, taking into account that the risks of exposing the patient to "mild" hypothermia are similar to the risks of moderate hypothermia. Furthermore, the study sought to weigh the benefits of "mild" hypothermia against those of normothermia with regards to their impact on tissue oxygen consumption.
purposes: To evaluate the total body oxygen consumption under different ranges of body temperature during surgery performed with the aid of CPB, ending with recommendations regarding the range of temperature that yield a preferential clinical outcome as a result of lower oxygen consumption.
Methods: between December 2014 and April 2015, 70 consecutive patients (55 males and 15 females), undergoing coronary artery bypass grafting surgery (CABG), allocated into three groups regarding the core temperature (Group 1 with normothermia 35-37°C, Group 2 with mild hypothermia 32-35°C, Group 3 with moderate hypothermia 28-32°C).
Results: There were no significant changes in Group 1 and Group 2 during CPB, however, for Group 3, there was a remarkable decrease in the oxygen consumption (VO2).
Conclusions: Moderate hypothermia rather than mild hypothermia proves to be of more benefit to the tissues when compared to normothermic conditions, as it significantly reduces tissue oxygen consumption. Moreover, even normothermia was found to be superior to mild hypothermia due to the latter’s adverse effects while maintaining similar results with regards to oxygen consumption.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. SLAVÍK J., MEDEK K., NESPOROVÁ J. 2003. "Normothermia in cardiac surgery with extracorporeal circulation, a review." SCRIPTA MEDICA (BRNO) 76 (6): 331–340.
3. Engelman R, Baker RA, Likosky DS, Grigore A, Dickinson TA, Shore-Lesserson L, Hammon JW. The STS/SCA/AmSECT: clinical practice guidelines for cardiopulmonary bypass—temperature management during cardiopulmonary bypass. Ann Thorac Surg 2015;100:748–57.
4. Murphy, Glenn S., Eugene A. Hessel II, and Robert C. Groom. "Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach." Anesthesia & Analgesia, 2009: pp 1394-1417.
5. Kwok M. Ho, Jen Aik Tan. "Benefits and Risks of Maintaining Normothermia during Cardiopulmonary Bypass in Adult Cardiac Surgery: A Systematic Review." Cardiovascular Therapeutics, 2011: 29: 260–279.
6. Walker, S.W. 2014. "Laboratory reference ranges." In Davidson’s Principles and Practice of Medicine, by Sir Stanley Davidson, 1307-1312. Elsevier Limited.
7. Ivan K. Crosby, Richard K. Zacour. 2014. "Cardiopulmonary Bypass." In Mastery of Cardiothoracic Surgery, by Irving L. Kron, Thomas L. Spray Larry R. Kaiser, 356-369. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business.
8. Jeremy M. Bennett, Andrew Shaw, and Chad Wagner. 2015. "Hypothermia and circulatory arrest." In Oxford Textbook of Cardiothoracic Anaesthesia, by Paul S. Myles, and Marco Ranucci R Peter Alston, 149-158. Oxford University Press.
9. Bryan V. Lich, D. Mark Brown. 2004. The manual of clinical perfusion. Fortmmyers, Florida: Perfusion.com publication.
10. Morgan G. Edward, Maged S. Mikhail. 2013. Morgan's Clinical Anesthesiology. 5. McGraw-Hill Education, LLC.
11. Staffan Svenmarker, So¨renHa¨ggmark, Magnus Hultin, Anders Holmgren. 2009. "Static blood-flow control during cardiopulmonary bypass is a compromise of oxygen delivery." European Journal of Cardio-thoracic Surgery.
12. Pittman, Roland. 2011. Regulation of Tissue Oxygenation. Biota Publishing.
13. Jeremiah R. Brown, Chirag R. Parikh. 2015. "Acute kidney injury after cardiac surgery in adults." In Perioperative Kidney Injury: Principles of Risk Assessment, Diagnosis and Treatment, by Chirag R. Parikh Charuhas V. Thakar, 85-98. NewYork: Springer sience+business media.
14. Munir Boodhwani, Fraser D. Rubens, Denise Wozny, and Howard J. Nathan. 2009. "Effects of Mild Hypothermia and Rewarming on Renal Function After Coronary Artery Bypass Grafting." Ann ThoracSurg 87 (95): 489.
15. Davies, Laurie K. 2008. "Temperature Management in Cardiac Surgery." In Cardiopulmonary Bypass: Principles and Practice, by Glenn P. Gravlee, Ric hard F. Davis, Alfred H. Stammers and Ross M. Ungerleider, 155-171. Lippincott Williams & Wilkins.
16. J. Ashmore, J. Pickett, J. Alder, R. Marks, and M. Thorniley. 2012. "Whole Body Oxygen Delivery and Consumption During Cardiopulmonary Bypass Surgery." In Oxygen Transport to Tissue XXXIII, by Hans Ulrich Bucher, Markus Rudin, Sabine Van Huffel, Ursula Wolf, Duane F. Bruley, David K. Harrison Martin Wolf, 229-234. New York: Springer Science+Business Media.
17. Eugene A. Hessel II, Joseph Nana Ghansah. 2013. "Pathophysiology of Cardiopulmonary Bypass." In Practical Approach to Cardiac Anesthesia, by Frederick A. Hensley, Donald E. Martin and Glenn P. Gravlee, 560-586. Philadelphia: Lippincott Williams & Wilkins.
18. Ioannis Sgouralis, Roger G. Evans, Bruce S. Gardiner, Julian A. Smith, Brendan C. Fry & Anita T. Layton. 2015. "Renal hemodynamics, function, and oxygenation during cardiac surgery performed on cardiopulmonary bypass: a modeling study." Physiological Reports 1-14.