Intraoperative temperature control using the Thermogard system during off-pump coronary artery bypass grafting.
OBJECTIVE
Normothermia during off-pump coronary bypass (OPCAB) grafting reduces metabolic derangements and contributes to improved clinical outcomes. Thus study examined the feasibility and efficacy of intraoperative temperature control using a novel endovascular heating system during OPCAB.


METHODS
Thirty-eight consecutive patients undergoing OPCAB were prospectively randomized to receive conventional warming (elevated room temperature, warmed intravenous fluids, warming blanket) or the Thermogard system (Alsius Corp, Irvine, CA). The triple-lumen temperature control Icy catheter (Alsius Corp) was inserted percutaneously into the inferior vena cava through common femoral vein. The catheter was removed after all wounds were closed. Temperature measurements (bladder, nasopharyngeal, and blood) were recorded at 5-minute intervals and compared between groups.


RESULTS
Patient demographics did not significantly differ between groups. The 17 Thermogard patients warmed at a significantly faster rate than the 21 control patients (0.28 degrees vs 0.11 degrees C/h, p = 0.03). Furthermore, Thermogard patients received more bypass grafts (3.4 +/- 0.6 vs 2.6 +/- 0.9, p < 0.001) and less intraoperative fluids (1557.0 +/- 547.7 vs 2012.3 +/- 723.1 mL, p = 0.02) despite longer operative times (150.3 +/- 123.4 vs 108.1 +/- 43.7 min; p = 0.12). All catheters were placed successfully on the first attempt, and there were no device-related complications.


CONCLUSIONS
Endovascular warming is safe, simple to use, and obviates the need for uncomfortably warm operating room temperatures. The Thermogard system compared favorably with conventional methods for warming during OPCAB.
Allen
Gary S
GS
Department of Cardiac Surgery, Memorial Regional Hospital, Hollywood, Florida, USA. gaallen@mhs.net
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002406:Catheterization, Peripheral / Q000295:instrumentation; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D017694:Rewarming / Q000295:instrumentation* / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013817:Thermography / Q000295:instrumentation*; D016896:Treatment Outcome; D014463:Ultrasonography