Drew-Anderson technique attenuates systemic inflammatory response syndrome and improves respiratory function after coronary artery bypass grafting.
BACKGROUND
Cardiopulmonary bypass causes inflammatory reactions leading to organ dysfunction postoperatively. This study was undertaken to determine whether using patients' own lungs as oxygenator in a bilateral circuit (Drew-Anderson Technique) could reduce systemic inflammatory response to cardiopulmonary bypass, improving patients clinical outcome following coronary artery bypass grafting.


METHODS
A prospective randomized controlled trial involving 30 patients, divided in two groups of 15 patients each, undergoing elective coronary artery bypass grafting, was undertaken. In the Drew-group bilateral extracorporeal circulation using patient's lung as oxygenator was performed. The other patients served as control group, where standard cardiopulmonary bypass procedure was used.


RESULTS
Pro-inflammatory and anti-inflammatory mediators were measured. Peak concentrations of proinflammatory interleukin-6, interleukin-8, were significantly lower in 15 patients undergoing Drew-Anderson Technique compared with the concentrations measured in 15 patients treated with standard cardiopulmonary bypass technique. Differences in patient recovery were analyzed with respect to time of intubation, blood loss, intrapulmonary shunting, oxygenation, and respiratory index. In patients undergoing uncomplicated coronary artery bypass grafting procedures bilateral extracorporeal circulation using the patients' own lung as oxygenator provided significant biochemical and clinical benefit in comparison to the standard cardiopulmonary bypass procedure.


CONCLUSIONS
This prospective randomized clinical study has demonstrated that exclusion of an artificial oxygenator from cardiopulmonary bypass circuit significantly decreases the activation of inflammatory reaction, and that interventions that attenuate this response may result in more favorable clinical outcome.
Richter
J A
JA
Department of Anesthesiology, German Heart Center, Technical University of Munich. richter@dhm.mhn.de
Meisner
H
H
Tassani
P
P
Barankay
A
A
Dietrich
W
W
Braun
S L
SL
D000368:Aged; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D005112:Extracorporeal Circulation / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007442:Intubation, Intratracheal; D008168:Lung / Q000502:physiology*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012119:Respiration; D012143:Respiratory Physiological Phenomena; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D010100:Oxygen