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Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome.

Abstract：

BACKGROUND:Vasoplegic syndrome is a form of vasodilatory shock that can occur after cardiopulmonary bypass (CPB). We hypothesized that the severity and duration of the decline in mean arterial pressure immediately after CPB is begun can be used as a predictor of patients will develop vasoplegia in the immediate post-CPB period and of poor clinical outcome. We quantified the decline in mean arterial pressure by calculating an area above the mean arterial blood pressure curve. METHODS AND RESULTS:We retrospectively analyzed 2823 adult cardiac surgery cases performed between July 2002 and December 2006. Of these 2823, 577 (20.4%) were vasoplegic after separation from CPB. We found that 1645 patients (58.3%) had a clinically significant decline in mean arterial pressure after starting CPB (area above the mean arterial blood pressure curve >0) and were significantly more likely to become vasoplegic (23.0% versus 16.9%; odds ratio, 1.26; 95% confidence interval, 1.12 to 1.43; P<0.001). These patients were also far more likely either to die in hospital or to have a length of stay >10 days (odds ratio, 3.30; 95% confidence interval, 1.44 to 7.57; P=0.005). Additional risk factors for developing vasoplegia that were identified included the additive euroSCORE, procedure type, prebypass mean arterial pressure, length of bypass, administration of pre-CPB vasopressors, core temperature on CPB, pre- and post-CPB hematocrit, the preoperative use of beta-blockers or angiotensin-converting enzyme inhibitors, and the intraoperative use of aprotinin. CONCLUSIONS:The results of this investigation suggest that it is possible to predict vasoplegia intraoperatively before separation from CPB and that the presence of a clinically significant area above the mean arterial blood pressure curve serves as a predictor of poor clinical outcome.

journal_name

Circulation

journal_title

Circulation

authors

Levin MA,Lin HM,Castillo JG,Adams DH,Reich DL,Fischer GW

doi

10.1161/CIRCULATIONAHA.108.814533

subject

Has Abstract

pub_date

2009-10-27 00:00:00

pages

1664-71

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.108.814533

journal_volume

120

pub_type

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Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome.