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Endotracheal bioimpedance cardiography improves immediate postoperative outcome: a case-control study in off-pump coronary surgery

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Abstract

The feasibility and clinical utility of the endotracheal cardiac output monitor (ECOM) to optimize intraoperative hemodynamics and improve short-term outcome in off-pump coronary artery bypass grafting (OPCAB) is unknown. We aimed to compare ECOM with a standard of care in that specific surgical setting. Twenty consecutive adult ECOM-monitored patients undergoing OPCAB were prospectively included (ECOM group) and retrospectively compared to 42 patients scheduled for similar surgery without ECOM monitoring (Control group). The primary endpoint was the global rate of postoperative admission to the intensive care unit (ICU). Secondary endpoints were the time to extubation, the length of stay in ICU and in hospital, the postoperative levels of lactate and troponin and the feasibility of ECOM. The rate of postoperative admission to the ICU was 38/42 (90%) in the Control group versus 11/20 (55%) in the ECOM group, P = 0.008. None unexpected admission for hemodynamic instability was observed in the ECOM group. The time to extubation, the length of stay in ICU, and both troponin level at admission and lactate level at H6 were all significantly decreased in the ECOM group. On a scale ranging from 0 to 5, convenience and satisfaction regarding ECOM were 4.30 ± 1.17 and 3.45 ± 0.68, respectively. The systematic use of ECOM is associated with a significant reduction in the rate of admission to the ICU and an improvement in immediate outcome in OPCAB.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France

    Thomas Leclercq, Marc Lilot, Thomas Schulz, Alexandre Meyer & Jean-Luc Fellahi

  2. Department of Cardiothoracic Surgery, Louis Pradel University Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69394, Lyon Cedex, France

    Fadi Farhat

  3. Inserm U1060, Faculty of Medicine Lyon Est, Claude Bernard Lyon 1 University, Lyon, France

    Jean-Luc Fellahi

Authors
  1. Thomas Leclercq
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  2. Marc Lilot
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  3. Thomas Schulz
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  4. Alexandre Meyer
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  5. Fadi Farhat
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  6. Jean-Luc Fellahi
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Correspondence to Thomas Leclercq.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Verbal consent was obtained from all individual participants included in the study.

Appendix 1: Scales for feasibility of ECOM in off-pump coronary surgery

Appendix 1: Scales for feasibility of ECOM in off-pump coronary surgery

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Leclercq, T., Lilot, M., Schulz, T. et al. Endotracheal bioimpedance cardiography improves immediate postoperative outcome: a case-control study in off-pump coronary surgery. J Clin Monit Comput 32, 81–87 (2018). https://doi.org/10.1007/s10877-017-9996-z

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  • DOI: https://doi.org/10.1007/s10877-017-9996-z

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