Cardiac anaesthesia

This chapter discusses the anaesthetic management of cardiac surgery. It begins with preoperative considerations, risk scoring for cardiac surgery, transoesophageal echocardiography and cardiopulmonary bypass (CPB). Surgical procedures covered include coronary artery bypass grafting (CABG) (including emergency and redo CABG); valve replacements and thoracic aortic surgery. Intraaortic balloon pumps and pulmonary hypertension are also covered.

Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry

Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS. Methods: The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality. Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89–3.94], P <0.001), body mass index <25 kg/m 2 (OR, 1.52 [95% CI, 1.08–2.16], P =0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44–3.23], P <0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54–4.95], P <0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88–5.95], P <0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16–4.63], P <0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07–2.24], P =0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25–2.76], P =0.002) were independent predictors for in-hospital mortality. Conclusions: The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02985008.

Effects of Duration of Using Intraaortic Balloon Pump on Renal Function and Clinical Outcome

Objective:To integrate the effects of duration of using intraaortic balloon pump (IABP) on renal function, major adverse cardiac events (MACEs) and all-cause mortality in patients with acute myocardial infarction (AMI) complicating pump failure. Methods:Between March 2017 and June 2018, a retrospective study enrolled 306 patients with AMI complicating pump failure who underwent coronary artery angiography (CAG) or percutaneous coronary intervention (PCI) was conducted. Patients were divided into the duration ≤4 days and the duration＞4 days in basis of median the IABP duration. We compared the renal function parameters at the three time section of IABP implantation between two groups. Analysis of factors of contrast-induced nephropathy (CIN), 12-month MACEs and all-cause mortality were also performed. Results:There were 146 patients in IABP duration ≤4 days and 92 patients in IABP duration > 4 days. Renal function was only correlated with IABP duration instead of timing of IABP implantation. On multivariate analysis, CIN risk increased by 81.2% (RR= 1.812, 95%CI, 1.167–3.763) for every 100mL increment of contrast agent. Hematocrit, blood platelet, IABP use >4 days were significantly inversely associated with CIN. Cox-regression analysis suggested that IABP duration was not significantly correlated with the incidence of 12-month MACEs and all-cause mortality. Conclusion:Longer duration of IABP implantation was beneficial to renal function, but was not significantly correlated with the incidence of 12-month MACEs and all-cause mortality in patients with AMI complicating pump failure. Patients undergoing PCI or CABG should notice that the potential damage of high dose of contrast agents on the renal function.