Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery.
The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n = 50) or a control group (control; n = 50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. A standard of care was used in the control. Goal-directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit (ICU). The primary endpoint was the time when patients fulfilled discharge criteria from hospital (possible hospital discharge). Secondary endpoints were the hospital discharge, the time to reach extubation, the length of stay in ICU, the number of major adverse cardiac events, and in-hospital mortality. Patients in the ECOM group received more often fluid loading and dobutamine. The time to reach extubation was reduced in the ECOM group: 510 min [360-1,110] versus 570 min [320-1,520], P = 0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI 0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI 0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity.
Department of Anesthesiology and Critical Care Medicine, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69677, Lyon-Bron Cedex, France, fellahi-jl@chu-caen.fr.
Jean-Luc
JL
Fellahi
David
D
Brossier
Fabien
F
Dechanet
Marc-Olivier
MO
Fischer
Vladimir
V
Saplacan
Jean-Louis
JL
Gérard
Jean-Luc
JL
Hanouz
D000368:Aged; D000465:Algorithms; D002302:Cardiac Output; D001026:Coronary Artery Bypass / Q000379:methods*; D004280:Dobutamine / Q000627:therapeutic use; D017097:Electric Impedance; D005260:Female; D005440:Fluid Therapy; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors
D004280:Dobutamine