Yogaratnam JZ, Laden G, Guvendik L, Cowen M, Cale A, Griffin S, et al.
Cardiovascular revascularization medicine : including molecular interventions. Date of publication 2010 Jan 1;volume 11(1):8-19.
1. Cardiovasc Revasc Med. 2010 Jan-Mar;11(1):8-19. doi:
10.1016/j.carrev.2009.03.004.
Hyperbaric oxygen preconditioning improves myocardial function, reduces length of
intensive care stay, and limits complications post coronary artery bypass graft
surgery.
Yogaratnam JZ(1), Laden G, Guvendik L, Cowen M, Cale A, Griffin S.
Author information:
(1)Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, HU16
JQ Cottingham, United Kingdom. jeysenzy@msn.com
OBJECTIVE: The objective of this study was to determine whether preconditioning
coronary artery disease (CAD) patients with HBO(2) prior to first-time elective
on-pump cardiopulmonary bypass (CPB) coronary artery bypass graft surgery (CABG)
leads to improved myocardial left ventricular stroke work (LVSW) post CABG. The
primary end point of this study was to demonstrate that preconditioning CAD
patients with HBO(2) prior to on-pump CPB CABG leads to a statistically
significant (P<.05) improvement in myocardial LVSW 24 h post CABG.
METHODS: This randomised control study consisted of 81 (control group=40; HBO(2)
group=41) patients who had CABG using CPB. Only the HBO(2) group received HBO(2)
preconditioning for two 30-min intervals separated 5 min apart. HBO(2) treatment
consisted of 100% oxygen at 2.4 ATA. Pulmonary artery catheters were used to
obtain perioperative hemodynamic measurements. All routine perioperative clinical
outcomes were recorded. Venous blood was taken pre HBO(2), post HBO(2) (HBO(2)
group only), and during the perioperative period for analysis of troponin T.
RESULTS: Prior to CPB, the HBO(2) group had significantly lower pulmonary
vascular resistance (P=.03). Post CPB, the HBO(2) group had increased stroke
volume (P=.01) and LVSW (P=.005). Following CABG, there was a smaller rise in
troponin T in HBO(2) group suggesting that HBO(2) preconditioning prior to CABG
leads to less postoperative myocardial injury. Post CABG, patients in the HBO(2)
group had an 18% (P=.05) reduction in length of stay in the intensive care unit
(ICU). Intraoperatively, the HBO(2) group had a 57% reduction in intraoperative
blood loss (P=.02). Postoperatively, the HBO(2) group had a reduction in blood
loss (11.6%), blood transfusion (34%), low cardiac output syndrome (10.4%),
inotrope use (8%), atrial fibrillation (11%), pulmonary complications (12.7%),
and wound infections (7.6%). Patients in the HBO(2) group saved US$116.49 per ICU
hour.
CONCLUSION: This study met its primary end point and demonstrated that
preconditioning CAD patients with HBO(2) prior to on-pump CPB CABG was capable of
improving LVSW. Additionally, this study also showed that HBO(2) preconditioning
prior to CABG reduced myocardial injury, intraoperative blood loss, ICU length of
stay, postoperative complications, and saved on cost, post CABG.
DOI: 10.1016/j.carrev.2009.03.004
PMID: 20129356 [Indexed for MEDLINE]
