Hyperlactatemia and its adverse patient outcomes among patients who underwent cardiopulmonary bypass surgery at national cardiac centre Addis Ababa, Ethiopia 2021. Retrospective observational study

Abstract Background: Hyperlactatemia and lactic acidosis are commonly encountered during and after cardiac surgery. Hyperlactatemia is highly suggestive of tissue ischemia and is associated with a prolonged intensive care unit stay, a prolonged requirement for respiratory and cardiovascular support, and increased postoperative mortality. Objective: To assess hyperlactatemia and adverse outcomes among patients who underwent cardiopulmonary bypass surgery at Cardiac Center Ethiopia, Addis Ababa, Ethiopia, 2021.Method: An institution-based retrospective cross-sectional study was employed among all patients who underwent cardiopulmonary bypass surgery from December to January 2020. Blood lactate samples were collected intraoperatively and postoperatively. We entered the collected data into Epidata version 4.2 and export it to SPSS 25 for analysis. We did descriptive statistics for categorical and continuous variables and chi-square to show an association between the outcome variable and independent variables. We entered variables fitted in bivariate analysis into multivariable analysis to show the strength of the association and the statistically significant variable.Result: The prevalence of hyperlactatemia in this study among patients who underwent cardiac surgery procedures at Cardiac Center Ethiopia was 37.5 %. A rise in lactate level prolongs ICU stay, prolongs intubation duration, and increases the need for Inotropes support. Lactate level was measured on the immediate postoperative day within 10 hours after the surgery and was defined as lactate level > 3 mmol/L in the first hour after surgery. Age > 40 years [AOR: 6.8 (95% CI 1.7-25), P=<0.008]. female gender [AOR: 1.8 (95% CI 1.1-3.8), P=0.048]. Variables statistically significant were declared at 95 % CI, p-value < 0.05.Conclusion and Recommended: An early rise in lactate levels in patients who underwent cardiopulmonary bypass surgery is a strong and robust predictor of morbidity. As a result, screening of patients in the preoperative period and strict follow-up management of those factors is recommended.

Download Full-text

Comparison between transcranial Doppler and Coulter counter for detection of lipid micro embolization from mediastinal shed blood reinfusion during cardiac surgery

Perfusion ◽

10.1177/0267659111419033 ◽

2011 ◽

Vol 26 (6) ◽

pp. 519-523

Author(s):

A Eyjolfsson ◽

F Al-Rashidi ◽

M Dencker ◽

S Scicluna ◽

B Brondén ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Transcranial Doppler ◽

Bypass Surgery ◽

Coulter Counter ◽

Shed Blood ◽

Non Invasive ◽

Cardiopulmonary Bypass Surgery ◽

Short And Long Term

Introduction: Lipid micro embolization (LME) from re-transfused shed blood has been postulated to be a potential reason for short- and long-term cognitive dysfunction after cardiac surgery. The purpose of this investigation was to evaluate if transcranial Doppler (TCD) has the capacity to detect LME. Methods: Thirteen patients undergoing cardiopulmonary bypass surgery were investigated. Each patient’s cerebral circulation was monitored with transcranial Doppler during the first two minutes after re-transfusion of shed blood and blood was simultaneously sampled and characterised by a Coulter counter. Results: Strong correlation was found between embolic loads, as measured by transcranial Doppler and Coulter counter (r=0.79, P<0.005). Conclusions: This pilot study shows that non-invasive monitoring by transcranial Doppler could be a potential tool to monitor LME during cardiopulmonary bypass surgery.

Download Full-text

Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery

Best Practice & Research Clinical Anaesthesiology ◽

10.1016/j.bpa.2003.12.004 ◽

2004 ◽

Vol 18 (3) ◽

pp. 425-438 ◽

Cited By ~ 61

Author(s):

Jan Larmann ◽

Gregor Theilmeier

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Bypass Surgery ◽

Cardiopulmonary Bypass Surgery

Download Full-text

Hemoglobin and Renal Replacement Therapy after Cardiopulmonary Bypass surgery: A predictive score from the Cardiac Surgery Registry of Puglia

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.08.003 ◽

2014 ◽

Vol 176 (3) ◽

pp. 866-873 ◽

Cited By ~ 7

Author(s):

Domenico Paparella ◽

Pietro Guida ◽

Valerio Mazzei ◽

Carmine Carbone ◽

Giuseppe Speziale ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Bypass Surgery ◽

Predictive Score ◽

Cardiopulmonary Bypass Surgery

Download Full-text

An evidence-based review of the use of vasoactive and inotropic medications in post-operative paediatric patients after cardiac surgery with cardiopulmonary bypass from 2000 to 2020

Cardiology in the Young ◽

10.1017/s1047951120004151 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1757-1771

Author(s):

Caitlin E. King ◽

Elizabeth J. Thompson ◽

Henry P. Foote ◽

Kanecia O. Zimmerman ◽

Kevin D. Hill ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Final Analysis ◽

High Risk Population ◽

Low Cardiac Output Syndrome ◽

Cardiopulmonary Bypass Surgery ◽

Childhood Morbidity ◽

Operative Care ◽

Meta Analyses

AbstractBackground:Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use.Methods:To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth – 18 years of age. Two reviewers independently reviewed studies to determine final eligibility.Results:The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses.Conclusion:Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.

Download Full-text

Prevalence of Heparin-Associated Antibodies Without Thrombosis in Patients Undergoing Cardiopulmonary Bypass Surgery

Circulation ◽

10.1161/01.cir.95.5.1242 ◽

1997 ◽

Vol 95 (5) ◽

pp. 1242-1246 ◽

Cited By ~ 241

Author(s):

Thomas L. Bauer ◽

Gowthami Arepally ◽

Barbara A. Konkle ◽

Bernadette Mestichelli ◽

Sandor S. Shapiro ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Cardiopulmonary Bypass Surgery

Download Full-text

Pulmonary infection after cardiopulmonary bypass surgery in children: a risk estimation model in China

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01450-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chunnian Ren ◽

Chun Wu ◽

Zhengxia Pan ◽

Quan Wang ◽

Yonggang Li

Keyword(s):

Risk Factors ◽

Cardiopulmonary Bypass ◽

Prediction Model ◽

Congenital Heart ◽

Bypass Surgery ◽

Pulmonary Infection ◽

Regression Analyses ◽

Cardiopulmonary Bypass Surgery ◽

Independent Risk Factors ◽

Individualized Prediction

Abstract Objectives The occurrence of pulmonary infection after congenital heart disease (CHD) surgery can lead to significant increases in intensive care in cardiac intensive care unit (CICU) retention time, medical expenses, and risk of death risk. We hypothesized that patients with a high risk of pulmonary infection could be screened out as early after surgery. Hence, we developed and validated the first risk prediction model to verify our hypothesis. Methods Patients who underwent CHD surgery from October 2012 to December 2017 in the Children’s Hospital of Chongqing Medical University were included in the development group, while patients who underwent CHD surgery from December 2017 to October 2018 were included in the validation group. The independent risk factors associated with pulmonary infection following CHD surgery were screened using univariable and multivariable logistic regression analyses. The corresponding nomogram prediction model was constructed according to the regression coefficients. Model discrimination was evaluated by the area under the receiver operating characteristic curve (ROC) (AUC), and model calibration was conducted with the Hosmer-Lemeshow test. Results The univariate and multivariate logistic regression analyses identified the following six independent risk factors of pulmonary infection after cardiac surgery: age, weight, preoperative hospital stay, risk-adjusted classification for congenital heart surgery (RACHS)-1 score, cardiopulmonary bypass time and intraoperative blood transfusion. We established an individualized prediction model of pulmonary infection following cardiopulmonary bypass surgery for CHD in children. The model displayed accuracy and reliability and was evaluated by discrimination and calibration analyses. The AUCs for the development and validation groups were 0.900 and 0.908, respectively, and the P-values of the calibration tests were 0.999 and 0.452 respectively. Therefore, the predicted probability of the model was consistent with the actual probability. Conclusions Identified the independent risk factors of pulmonary infection after cardiopulmonary bypass surgery. An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery. For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection.

Download Full-text