Predictors of inotrope use during separation from cardiopulmonary bypass.
OBJECTIVE
To identify the demographic, clinical, and echocardiographic features that predict the use of inotropic support at separation from cardiopulmonary bypass (CPB).


METHODS
Retrospective study of consecutive patients undergoing coronary artery bypass graft (CABG) surgery.


METHODS
Referral center for cardiothoracic surgery at a university hospital.


METHODS
One thousand nine patients undergoing either CABG or combined CABG and valve surgery with CPB in whom an intraoperative transesophageal echocardiography (TEE) examination was performed.


METHODS
Inotropic support was defined as the use of dopamine >/=5 microg/kg/min; any dose of epinephrine, norepinephrine, dobutamine, and milrinone; or the insertion of an IABP during separation from CPB. Support was implemented by the anesthesia care team as clinically indicated. Comprehensive TEE examinations were conducted before CPB in all patients according to published guidelines and subsequently reviewed by a single, independent operator.


RESULTS
Inotropic support was used in a total of 394 patients (39%) at separation from CPB. The study identified 6 significant, independent predictors of inotrope use: (1) Wall Motion Score Index, (2) combined CABG and mitral valve repair or replacement surgery, (3) left ventricular ejection fraction <35%, (4) reoperation, (5) moderate-to-severe mitral regurgitation, and (6) aortic cross-clamp time.


CONCLUSIONS
Incorporating data from a comprehensive intraoperative TEE examination, the authors identified 6 reproducible factors that independently predict the use of inotropic support at separation from CPB.
McKinlay
Kenneth H
KH
Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Schinderle
David B
DB
Swaminathan
Madhav
M
Podgoreanu
Mihai V
MV
Milano
Carmelo A
CA
Messier
Robert H
RH
El-Moalem
Habib
H
Newman
Mark F
MF
Clements
Fiona M
FM
Mathew
Joseph P
JP
D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002395:Catecholamines / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D004298:Dopamine / Q000008:administration & dosage; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D016343:Monitoring, Intraoperative; D009200:Myocardial Contraction; D012086:Reoperation; D012307:Risk Factors; D013318:Stroke Volume
D002316:Cardiotonic Agents; D002395:Catecholamines; D020105:Milrinone; D004298:Dopamine