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IMPROVED OUTCOMES DURING CARDIAC SURGERY- A MULTIFACTORIAL ENHANCEMENT OF TECHNIQUES OF CARDIOPULMONARY BYPASS |
Stammers AH,
Trowbridge C,
Yen B,
Murdock J,
Klayman M
IMPROVED OUTCOMES DURING CARDIAC SURGERY- A MULTIFACTORIAL ENHANCEMENT OF TECHNIQUES OF CARDIOPULMONARY BYPASS
Patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) are more likely to have pre-existing comorbidities, which has resulted in a steady increase in the risk associated with CPB. The resulting challenge has mandated the optimization of perfusion care. The purpose of this study was to retrospectively evaluate the impact of a number of aggregate, evidence based perfusion care changes on patient outcome. After Institutional Review Board approval, two groups of patients were compared. The control group (n=420) included all patients undergoing CPB in a
18-month period preceding a multifaceted change in perfusion techniques. The treatment group (n=272) included all patients undergoing CPB after the following changes:
Multifactorial enhancement of perfusion techniques.
*Phosphorylchorline coated circuitry (COBE Cardiovascular, Colorado, USA)
*Continuous arterial and venous in-line blood gas monitoring (Terumo Card.,Michigan USA)
*Dedicated myocardial protection system (Quest Medical, Texas, USA)
*Centrifugal Pump (COBE Cardiovascular, Colorado, USA)
*Thromboelastograph whole blood coagulation monitoring (Haemoscope CO.Illinois, USA)
*Continuous Autotransfusion System (Terumo Card., Michigan USA)
*Prime solution with albumin replacing high molecular weight starch
*Perfusion clinician quality improvement plan
After matching the groups by procedure, multiple variables were analyzed, including demographic, preoperative, operative, and postoperative parameters. Both univariate and multivariate methods of analysis were included, which utilized
propensity analysis and balancing score technologies.
The treatment group had a lower mortality rate than the control group (2.9% vs 9.3%, p=0.001) despite being similar in predicted mortality (10.1±7.6% vs 9.7±8.1%, p=NS) and other preoperative and operative parameters. The lower mortality rate was concurrent with a lower incidence of reoperation for bleeding (8.8% vs 4.4%, p=0.018), sternal infection (2.6% vs 0.7%, p=0.062), permanent stroke (3.3% vs 1.1%, p=0.050), and cardiac arrest (3.8% vs 1.1%, p=0.025), and a trend of decreasing rates for other complications.
In conclusion, the patients treated after evidence based changes in CPB care were implemented had a decreased complication and mortality rate. Changes in perfusion practice can be implemented to improve the overall outcome of patients undergoing cardiac surgery.
Reference:
Stammers AH, Trowbridge C, Yen B, Murdock J, Klayman M.
IMPROVED OUTCOMES DURING CARDIAC SURGERY- A MULTIFACTORIAL ENHANCEMENT OF TECHNIQUES OF CARDIOPULMONARY BYPASS.
JECT 2005;37:419.
Institution(s):
Geisinger Medical Center, Danville, Pennsylvania,
Category:
Abstract
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