Emergency cardiac mechanical assistance: place of mucosal gastric tonometry as prognostic indicator.
OBJECTIVE
The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO(2)) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device.


METHODS
In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO(2) (PgCO(2)) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death.


RESULTS
Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 +/- 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO(2) on admission to ICU (P = 0.040) and norepinephrine dose at 24 h.


CONCLUSIONS
Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.
Rosamel
P
P
Service d'Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France.
Flamens
C
C
Paulus
S
S
Cannesson
M
M
Bastien
O
O
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D002315:Cardiopulmonary Bypass; D003422:Critical Care; D004638:Emergency Treatment; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009102:Multiple Organ Failure / Q000209:etiology; D009638:Norepinephrine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D013152:Splanchnic Circulation / Q000502:physiology; D013997:Time Factors
D000316:Adrenergic alpha-Agonists; D009638:Norepinephrine