Thermo-wrap technology preserves normothermia better than routine thermal care in patients undergoing off-pump coronary artery bypass and is associated with lower immune response and lesser myocardial damage.
OBJECTIVE
Perioperative hypothermia might be detrimental to the patient undergoing off-pump coronary artery bypass surgery. We assessed the efficacy of the Allon thermoregulation system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) compared with that of routine thermal care in maintaining normothermia during and after off-pump coronary artery bypass surgery.


METHODS
Patients undergoing off-pump coronary artery bypass surgery were perioperatively and randomly warmed with the 2 techniques (n = 45 per group). Core temperature, hemodynamics, and troponin I, interleukin 6, interleukin 8, and interleukin 10 blood levels were assessed.


RESULTS
The mean temperature of the patients in the Allon thermoregulation system group (AT group) was significantly ( P < .005) higher than that of the patients receiving routine thermal care (the RTC group); less than 40% of the latter reached 36 degrees C compared with 100% of the former. The cardiac index was higher and the systemic vascular resistance was lower ( P < .05) by 16% and 25%, respectively, in the individuals in the AT group compared with in the individuals in the RTC group during the 4 postoperative hours. End-of-surgery interleukin 6 levels and 24-hour postoperative troponin I levels were significantly ( P < .01) lower in the patients in the AT group than in the RTC group. The RTC group's troponin levels closely correlated with their interleukin 6 levels at the end of the operation ( R = 0.51, P = .002).


CONCLUSIONS
Unlike routine thermal care, the Allon thermoregulation system maintains core normothermia in more than 80% of patients undergoing off-pump coronary artery bypass surgery. Normothermia is associated with better cardiac and vascular conditions, a lower cardiac injury rate, and a lower inflammatory response. The close correlation between the increased interleukin 6 and troponin I levels in the routine thermal care group indicates a potential deleterious effect of lowered temperature on the patient's outcome.
Nesher
Nahum
N
Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Uretzky
Gideon
G
Insler
Steven
S
Nataf
Patrick
P
Frolkis
Inna
I
Pineau
Emmanuelle
E
Cantoni
Emmanuel
E
Bolotin
Gil
G
Vardi
Moshe
M
Pevni
Dimitry
D
Lev-Ran
Oren
O
Sharony
Ram
R
Weinbroum
Avi A
AA
D000368:Aged; D001831:Body Temperature; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007035:Hypothermia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D011446:Prospective Studies