scholarly journals Energy Level and Success of Internal Defibrillation for Shockable Rhythm during Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective Study

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Wirat Wasinwong ◽  
Mantana Saetang ◽  
Thavat Chanchayanon
Keyword(s):  
Cardiac Surgery ◽  
Ventricular Tachycardia ◽  
Success Rate ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Valve Surgery ◽  
Artery Bypass Graft ◽  
Shockable Rhythm ◽  
Valvular Surgery ◽  
Internal Defibrillation

Internal defibrillation is commonly indicated for shockable rhythm following cross-clamp removal in cardiac surgery. Low energy decreases the success rate of defibrillation but high energy can cause myocardial damage. This study aimed to determine the success rate of internal defibrillation for shockable arrhythmias after cardiac surgery.Retrospective data of 1,424 patients who developed shockable rhythms (ventricular fibrillation or ventricular tachycardia), and required internal defibrillation after aortic cross-clamp removal during cardiac surgery, without deep hypothermic circulatory arrest technique, from August 2015 to July 2017, were reviewed.The overall success rate of internal defibrillation in the first attempt of defibrillation was 61.5%. The success rate of the energy levels at 30, 10, and 7 Jules were 66.7, 64.9, and 61.5%, respectively. The success rate was higher in patients who had a better ejection fraction than those who failed after defibrillation. This was significantly associated with higher pH, higher bicarbonate, lower serum calcium, and lower total cardioplegic volume during cardiopulmonary bypass (CPB). Redo-valve surgery, valvular surgery, and combined coronary artery bypass graft with valvular surgery had a non-significantly lower success rate (p-value = 0.989). Incidence of failure for defibrillate patients in redo-valvular surgery, combined coronary artery bypass graft with valve surgery, adult congenital heart defect, and valvular surgery; requiring four or five shocks was non-significantly increased. Recurrent rate of ventricular fibrillation/ventricular tachycardia was 13.5%.The success rate of internal defibrillation was not related to the dose of energy used after being weaned off CPB.

scholarly journals Pleural effusion in patients undergoing coronary artery bypass graft and valve replacement: a population study

2018 ◽  
Vol 4 (3) ◽  
pp. 167
Author(s):  
Maria Rossolatou ◽  
Dimitris Papageorgiou ◽  
Georgia Toylia ◽  
Georgios Vasilopoulos
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Pleural Effusion ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Valve Surgery ◽  
Artery Bypass Graft

Introduction: The postoperative pleural effusion (PE) is common in patients who undergo cardiac surgery. Most of these effusions develop as a consequence of the surgical procedure itself and follow a generally benign course. The characteristics of PE and the factors predisposing factors should be documented further.Aim: The aim of this study was to determine the prevalence of PE after cardiac surgery. And also to determine whether this prevale is related to the type of cardiac surgery.Material and Methods: This retrospective study was conducted at a large private hospital in Athens. The sample of the study was all adult patients who undergo coronary artery bypass graft (CABG), valve replacement or a combination of these surgeries. A special form was made to record patients’ demographic and clinical data. Descriptive statistics and correlation studies were performed with the SPSS 22.0, at significant level a=0.05.Results: Among the 118 patients, who included in this study, 42.4% underwent CABG surgery, 29.7% valve surgery, and 28% a combination of two types of surgery. Postoperative pleural effusion was developed in 40% of those who underwent CABG, 42.9% of those who underwent cardiac valve surgery, and 42.4% of those who underwent in both types of surgeries. The mean time development of PE was 6.65 days for the CABG group, 4.8 days for the valve group and 8.7 days for the CABG +valve group. There was no statistically significant difference in the demographic and clinical data of patients with pleural effusion according the type of cardiac surgery.Conclusions: Postoperative PE is a common complication at cardiac surgery and is more common in patients undergoing surgical recuperation of valve.

scholarly journals Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery

2018 ◽  
Vol 10 (4) ◽  
pp. 192-196 ◽  
Author(s):  
Masoud Tarbiat ◽  
Maryam Davoudi ◽  
Sayed Ahmadreza Salimbahrami
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Success Rate ◽  
Subclavian Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Neutral Group ◽  
Significant Difference ◽  
Vein Catheterization

Introduction: Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. The aim of this study was to evaluate influence of arm position during infraclavicular subclavian vein catheterization with landmark-based technique in coronary artery bypass graft (CABG) surgery. Methods: Between September 2017 and June 2018, this prospective randomized clinical trial was performed in 320 patients. The patients were randomly assigned to the Neutral group (the arms kept by the side) or Abduction group (the arm was abducted to 90°). The success and complication rates were compared in the two groups. The data were analyzed using SPSS software. Results: In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). The overall success rate in two attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral group. There was a significant difference between two groups in the second and overall success rates (P = 0.0001). In 34 (10.6%) patients, subclavian artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%) in the Neutral group. There was a significant difference between two groups (P = 0.0001). Pneumothorax was occurred in 15 (9.4%) in the Abduction group and 3 (1.9%) in the Neutral group. There was also a significant difference between two groups (P = 0.004). The differences in other complications on two groups were statistically insignificant. Conclusion: Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. The incidences of other complications were similar on both groups.

Cardiac Surgery Nurse Practitioner Home Visits Prevent Coronary Artery Bypass Graft Readmissions

2014 ◽  
Vol 97 (5) ◽  
pp. 1488-1495 ◽  
Author(s):  
Michael H. Hall ◽  
Rick A. Esposito ◽  
Renee Pekmezaris ◽  
Martin Lesser ◽  
Donna Moravick ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Nurse Practitioner ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Home Visits ◽  
Artery Bypass Graft

scholarly journals The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Leerang Lim ◽  
Karam Nam ◽  
Seohee Lee ◽  
Youn Joung Cho ◽  
Chan-Woo Yeom ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cerebral Oximetry ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
The Relationship

Abstract Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients

2016 ◽  
Vol 9 (2) ◽  
pp. 236-248
Author(s):  
Alicia Williams ◽  
Lyn Stankiewicz Murphy
Keyword(s):  
Cardiac Surgery ◽  
Content Validity ◽  
Patient Population ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Interrater Agreement ◽  
Early Extubation ◽  
Artery Bypass Graft ◽  
Validity Index ◽  
Item Content

Introduction:Patients undergoing coronary artery bypass graft surgery will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes but also organizational outcomes as well. Patients who are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the postoperative cardiac surgical adult patient.Methods:For the purpose of establishing content validity of an early extubation protocol, 2 protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol based on a 5-question survey. Their response was used to calculate a scale-content validity index (S-CVI) and an item-content validity index (I-CVI).Results:Twelve of 15 experts participated in the project. The content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI) and (b) S-CVI. The means were established for each item. Content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI: 0.75–1.00); and the S-CVI/average = 0.92. Cronbach’s alpha was estimated to establish reliability (0.972).Conclusion:Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in postoperative cardiac surgery patients.

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