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

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.

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

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.

Seizure After Cardiopulmonary bypass Surgery: A Retrospective Study

Background: We are to investigate prognostic factors of seizure after cardiopulmonary bypass surgery based on the incidence, the operation parameters, and the outcomes of seizure.Methods: Consecutive patients presented a seizure after a cardiac or aortic surgery using a cardiopulmonary bypass (CPB) during the admission between January 2006 and January 2019 were retrospectively enrolled. Patients with a previous seizure history were excluded. The medical records were reviewed on the demographics, associated medical conditions, laboratory, electroencephalography (EEG), and imaging findings, cardiopulmonary bypass parameters, types of seizure, and prognosis.Results: Among the 488 patients who received cardiopulmonary surgery using CPB, 29 patients were diagnosed with seizure during admission. There were nine cases of aortic valve replacement, six of mitral valve replacement, four of aorta graft, two of patent ductus arteriosus closure, coronary artery bypass graft, tricuspid annuloplasty, and tumor resection for each. The average durations of the operation and of cardiopulmonary bypass were 278±119 and 108±55 minutes, respectively. The average aortic cross clamping time was 72±41 minutes. The median detection time of a seizure was 34.38±83.37 hours after surgery. Twenty-three patients (79.3%) did not show recovery of mental status after surgery until the seizure was detected. Seventeen patients were diagnosed with status epilepticus, and two of them had nonconvulsive status epilepticus. Nine showed repetitive seizures and three presented a single seizure. EEG analysis showed five cases of spike-and-wave, four of periodic discharges, four of rhythmic delta, and one of burst suppression. From the image studies, sixteen patients showed stroke, two revealed posterior reversible encephalopathy syndrome, and two showed seizure related changes. Nine (31.0%) expired in 25±27 postoperative day. For the survived patients, the average duration of ICU admission was 9±7 days.Conclusions: Due to its difficulty of detecting preclinical seizure after the surgery, evaluation including performance of EEG in early postoperative phase should be considered.