Pulse Indicated Continuous Cardiac Output for Low Cardiac Output Patients after Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIFei , JIAMing , DONGPing ,  HOUXiao-tong

Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding author：

HOUXiao-tong, Email: xt.hou@ccmu.edu.cn

Keywords：

Coronary artery bypass grafting; Pulse indicated continuous cardiac output; Low cardiac output syndrome

DOI：

10.7507/1007-4848.20160057

Video：

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Objective To analyze the significance of application of pulse indicated continuous cardiac output (PICCO) as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting (CABG) operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80±9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. Results Comparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump (IABP) usage (t=2.155, P=0.039), less usage rate of endotracheal reintubation (χ²=5.098, P=0.039), shorter average postoperative mechanical ventilation time (t=2.087, P=0.044), less occurrence rate of cardiac arrhythmia (χ²=4.011, P=0.045), less occurrence rate of multiple organ dysfunction syndrome (MODS) (χ²=5.075, P=0.035), shorter days in ICU (t=2.141, P=0.040) and in-hospital time (t=2.061 P=0.048). During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction (LVEF) than those in the non-PICCO group. Conclusion The application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.

Citation： LIFei, JIAMing, DONGPing, HOUXiao-tong. Pulse Indicated Continuous Cardiac Output for Low Cardiac Output Patients after Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 239-243. doi: 10.7507/1007-4848.20160057 Copy

1.	Baillot RG, Joanisse DR, Stevens LM, et al. Recent evolution in demographic and clinical characteristics and in-hospital morbidity in patients undergoing coronary surgery. Can J Surg, 2009, 52: 394-400.
2.	Ding W, Ji Q, Shi Y, et al. Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting. Int Heart J, 2015, 56(2): 144-149.
3.	房勤, 谷天祥, 刘波, 等. 左心室射血分数低下患者行冠状动脉旁路移植术. 中国胸心血管外科临床杂志, 2012, 19(4): 433-434.
4.	李京倖, 顾承雄, 韦华, 等. 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志, 2011, 18(2): 157-159.
5.	Sá MP, Nogueira JR, Ferraz PE,et al. Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2012, 27(2): 217-23.
6.	Ding W, Ji Q, Wei Q, et al. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Ann Intensive Care, 2015, 131(2): 109-115.
7.	Miceli A, Fiorani B, Danesi TH, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting: a propensity score analysis. Interact Cardiovasc Thorac Surg, 2009, 9(2): 291-294.
8.	Gassanov N, Caglayan E, Nia A, et al. The PICCO catheter. Dtsch Med Wochenschr, 2010, 135(46): 2311-2314.
9.	Algarni KD, Maganti M, Yau TM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: trends over 20 years. Ann Thorac Surg, 2011, 92(5): 1678-1684.
10.	Rao V, Ivanov J, Weisel RD, et al. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg, 1996, 112: 38-51.
11.	Oliveira TM, Oliveira GM, Klein CH, et al. Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003. Arq Bras Cardiol, 2010, 95(3): 303-312.
12.	Santarpino G, Onorati F, Rubino AS, et al. Preoperative intra aortic balloon pumping improves outcomes for high risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87: 488.
13.	Rovira L, Aguilar G, Cuñat A, et al. Late evaluation of upper limb arterial flow in patients after long radial (PiCCO^TM) catheter placement. Int Heart J, 2015, 56(2): 144-149.
14.	Halvorsen PS, Espinoza A, Lundblad R,et al. Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery. Acta Anaesthesiol Scand, 2006, 50(9): 1050-1057.
15.	Riabova OS, Vyzhigina MA, Zhukova SG, et al. Application of two dilution techniques using Swan-Ganz-REF and PICCO-Plus technologies to the evaluation of systemic and pulmonary circulation. Anesteziol Reanimatol, 2005, 6: 46-54.
16.	Huber W, Koenig J, Mair S, et al. Predictors of the accuracy of pulse-contour cardiac index and suggestion of a calibration-index: a prospective evaluation and validation study. BMC Anesthesiol, 2015, 15: 45.
17.	Fernandez-Mondejar E, Rivera-FernandezR, Garcia-Delgado M, et al. Small increases in extravascular lung water areaccurately detected by transpulmonarythermodilution. J Trauma, 2005, 59(6): 1420-1423.
18.	孟蕾, 于湘友. PiCCO系统临床应用进展. 中华实用诊断与治疗杂志, 2011, 25(1): 3-5.
19.	Halvorsen PS, Sokolov A, Cvancarova M, et al. Continuous cardiac output during off-pump coronary artery bypass surgery: pulse-contour analyses vs pulmonar yartery thermodilution. Br J Anaesth, 2007, 99(4): 484-492.
20.	Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med, 2007, 35(1): 64-68.
21.	Marik PE, Baram M, Vabid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008, 134(1): 172-178.
22.	Brogly N, Schiraldi R, Puertas L, et al. Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus^®) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. Rev Bras Anestesiol, 2014, 28: S0034-7094.
23.	Bindels AJGH, Vander hoeven JG, Grafland AD, et al. Relationships between volume and pressure measurements and stoke volume in critically ill patients. Criteare, 2000, 4: 193-199.
24.	刘松桥, 邱海波, 杨毅, 等. 胸腔内血容量指数对失血性休克犬容量状态评价的意. 外科理论及实践, 2006, 11(1): 24-27.
25.	Van Lieshout JJ, Harms MP, Pott F, et al. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans. Acta Anaesthesiol Scand,2005, 49(9): 1287-1292.

1. Baillot RG, Joanisse DR, Stevens LM, et al. Recent evolution in demographic and clinical characteristics and in-hospital morbidity in patients undergoing coronary surgery. Can J Surg, 2009, 52: 394-400.
2. Ding W, Ji Q, Shi Y, et al. Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting. Int Heart J, 2015, 56(2): 144-149.
3. 房勤, 谷天祥, 刘波, 等. 左心室射血分数低下患者行冠状动脉旁路移植术. 中国胸心血管外科临床杂志, 2012, 19(4): 433-434.
4. 李京倖, 顾承雄, 韦华, 等. 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志, 2011, 18(2): 157-159.
5. Sá MP, Nogueira JR, Ferraz PE,et al. Risk factors for low cardiac output syndrome after coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2012, 27(2): 217-23.
6. Ding W, Ji Q, Wei Q, et al. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Ann Intensive Care, 2015, 131(2): 109-115.
7. Miceli A, Fiorani B, Danesi TH, et al. Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting: a propensity score analysis. Interact Cardiovasc Thorac Surg, 2009, 9(2): 291-294.
8. Gassanov N, Caglayan E, Nia A, et al. The PICCO catheter. Dtsch Med Wochenschr, 2010, 135(46): 2311-2314.
9. Algarni KD, Maganti M, Yau TM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: trends over 20 years. Ann Thorac Surg, 2011, 92(5): 1678-1684.
10. Rao V, Ivanov J, Weisel RD, et al. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg, 1996, 112: 38-51.
11. Oliveira TM, Oliveira GM, Klein CH, et al. Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003. Arq Bras Cardiol, 2010, 95(3): 303-312.
12. Santarpino G, Onorati F, Rubino AS, et al. Preoperative intra aortic balloon pumping improves outcomes for high risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 87: 488.
13. Rovira L, Aguilar G, Cuñat A, et al. Late evaluation of upper limb arterial flow in patients after long radial (PiCCO^TM) catheter placement. Int Heart J, 2015, 56(2): 144-149.
14. Halvorsen PS, Espinoza A, Lundblad R,et al. Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery. Acta Anaesthesiol Scand, 2006, 50(9): 1050-1057.
15. Riabova OS, Vyzhigina MA, Zhukova SG, et al. Application of two dilution techniques using Swan-Ganz-REF and PICCO-Plus technologies to the evaluation of systemic and pulmonary circulation. Anesteziol Reanimatol, 2005, 6: 46-54.
16. Huber W, Koenig J, Mair S, et al. Predictors of the accuracy of pulse-contour cardiac index and suggestion of a calibration-index: a prospective evaluation and validation study. BMC Anesthesiol, 2015, 15: 45.
17. Fernandez-Mondejar E, Rivera-FernandezR, Garcia-Delgado M, et al. Small increases in extravascular lung water areaccurately detected by transpulmonarythermodilution. J Trauma, 2005, 59(6): 1420-1423.
18. 孟蕾, 于湘友. PiCCO系统临床应用进展. 中华实用诊断与治疗杂志, 2011, 25(1): 3-5.
19. Halvorsen PS, Sokolov A, Cvancarova M, et al. Continuous cardiac output during off-pump coronary artery bypass surgery: pulse-contour analyses vs pulmonar yartery thermodilution. Br J Anaesth, 2007, 99(4): 484-492.
20. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med, 2007, 35(1): 64-68.
21. Marik PE, Baram M, Vabid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 2008, 134(1): 172-178.
22. Brogly N, Schiraldi R, Puertas L, et al. Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus^®) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. Rev Bras Anestesiol, 2014, 28: S0034-7094.
23. Bindels AJGH, Vander hoeven JG, Grafland AD, et al. Relationships between volume and pressure measurements and stoke volume in critically ill patients. Criteare, 2000, 4: 193-199.
24. 刘松桥, 邱海波, 杨毅, 等. 胸腔内血容量指数对失血性休克犬容量状态评价的意. 外科理论及实践, 2006, 11(1): 24-27.
25. Van Lieshout JJ, Harms MP, Pott F, et al. Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humans. Acta Anaesthesiol Scand,2005, 49(9): 1287-1292.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Pulse Indicated Continuous Cardiac Output for Low Cardiac Output Patients after Coronary Artery Bypass Grafting

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