Endotracheal bioimpedance cardiography improves immediate postoperative outcome: a case-control study in off-pump coronary surgery.
The feasibility and clinical utility of the endotracheal cardiac output monitor (ECOM) to optimize intraoperative hemodynamics and improve short-term outcome in off-pump coronary artery bypass grafting (OPCAB) is unknown. We aimed to compare ECOM with a standard of care in that specific surgical setting. Twenty consecutive adult ECOM-monitored patients undergoing OPCAB were prospectively included (ECOM group) and retrospectively compared to 42 patients scheduled for similar surgery without ECOM monitoring (Control group). The primary endpoint was the global rate of postoperative admission to the intensive care unit (ICU). Secondary endpoints were the time to extubation, the length of stay in ICU and in hospital, the postoperative levels of lactate and troponin and the feasibility of ECOM. The rate of postoperative admission to the ICU was 38/42 (90%) in the Control group versus 11/20 (55%) in the ECOM group, P = 0.008. None unexpected admission for hemodynamic instability was observed in the ECOM group. The time to extubation, the length of stay in ICU, and both troponin level at admission and lactate level at H6 were all significantly decreased in the ECOM group. On a scale ranging from 0 to 5, convenience and satisfaction regarding ECOM were 4.30 ± 1.17 and 3.45 ± 0.68, respectively. The systematic use of ECOM is associated with a significant reduction in the rate of admission to the ICU and an improvement in immediate outcome in OPCAB.
Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France. leclercq.t@gmail.com.
Thomas
http://orcid.org/0000-0002-3062-7790
T
Leclercq
Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France.
Marc
M
Lilot
Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France.
Thomas
T
Schulz
Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France.
Alexandre
A
Meyer
Department of Cardiothoracic Surgery, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France.
Fadi
F
Farhat
Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France.|Inserm U1060, Faculty of Medicine Lyon Est, Claude Bernard Lyon 1 University, Lyon, France.
Jean-Luc
JL
Fellahi
D000368:Aged; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass / Q000379:methods; D016022:Case-Control Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation* / Q000379:methods*; D003422:Critical Care; D017097:Electric Impedance; D004867:Equipment Design; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007432:Intraoperative Period; D019344:Lactic Acid / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D059035:Perioperative Period; D011184:Postoperative Period; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014336:Troponin / Q000097:blood
D014336:Troponin; D019344:Lactic Acid
Cardiac surgery; Endotracheal bioimpedance cardiography; Hemodynamic monitoring; Off-pump coronary artery bypass grafting