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Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: the CARDIOX randomized clinical trial

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Abstract

Purpose

Data on the benefit or or harmful effects of oxygen level on ischemic reperfusion injuries in cardiac surgery are insufficient. We hypothesized that hyperoxia during cardiopulmonary bypass decreases the incidence of postoperative atrial fibrillation (POAF) and ventricular fibrillation, and therefore decreases cardiovascular morbidity (CARDIOX study).

Methods

An open-label, randomized clinical trial including adults undergoing elective cardiac surgery, i.e. cardiopulmonary bypass (CPB) randomized 1:1 to an intervention group or standard group at two French University Hospitals from June 2016 to October 2018. The intervention consisted in delivering of an inspired fraction of oxygen of one to one during CPB. The standard care consisted in delivering oxygen to achieve a partial arterial blood pressure less than 150 mmHg. The primary endpoint was the occurrence of POAF and/or ventricular tachycardia/ventricular fibrillation (VT/VF) within the 15 days following cardiac surgery. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACCE: in-hospital mortality, stroke, cardiac arrest, acute kidney injury, and mesenteric ischemia).

Results

330 patients were randomly assigned to either the intervention group (n = 161) or the standard group (n = 163). Mean PaO2 was 447 ± 98 mmHg and 161 ± 60 mmHg during CPB, for the intervention and standard group (p < 0.0001) respectively. The incidence of POAF or VT/VF were similar in the intervention group and the standard group (30% [49 of 161 patients] and 30% [49 of 163 patients], absolute risk reduction 0.4%; 95% CI, − 9.6–10.4; p = 0.94). MACCE was similar between groups with, an occurrence of 24% and 21% for the intervention group and the standard groups (absolute risk reduction 3.4%; 95% CI, − 5.7–12.5; p = 0.47) respectively. After adjustment, the primary and secondary endpoints remained similar for both groups.

Conclusion

Hyperoxia did not decrease POAF and cardiovascular morbidity following cardiac surgery with CPB.

Clinicaltrial.gov identifier

NCT02819739.

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Acknowledgements

Data were collected by representatives of Clinical Research Divisions of Amiens (Estelle Josse) and Dijon University Hospital (Clémence Beauvalot). The first draft of the manuscript was written by Dr Osama Abou-Arab, Dr Pierre Huette and Pr Pierre-Grégoire Guinot with review and revision by the others authors. Statistical analysis was performed by Mr Momar Diouf. The authors would like to thank CARDIOX participating centers: Centre hospitalier universitaire de Picardie (Yazine Mahjoub, MD, PhD; Mathieu Guilbart, MD; Patricia Besserve, MD; Beatris Labont, MD; Abdel Hchikat, MD; Amar Ben-Ammar, MD; Hervé Dupont, MD, PhD; Thierry Caus, MD, PhD; Jean-Paul Remadi, MD) and Centre hospitalier universitaire de Dijon (Anis Missaoui, MD; Omar Ellouze, MD; Tiberiu Constandache, MD; Sandrine Grosjean, MD; Vivien Berthoud, MD; Jean-Philippe Parthiot, MD; Jean-Pierre Merle, MD).

Funding

The study was sponsored by Amiens University Hospital.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, 1, Rue du Professeur Christian Cabrol, 80054, Amiens, France

    Osama Abou-Arab, Pierre Huette, Lucie Martineau, Christophe Beyls & Emmanuel Lorne

  2. MP3CV, EA7517, CURS, Jules Verne University of Picardy, 80054, Amiens, France

    Osama Abou-Arab

  3. Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, 14033, Dijon, France

    Clémence Beauvalot, Belaïd Bouhemad & Pierre-Grégoire Guinot

  4. Department of Clinical Research, Amiens Picardy University Hospital, 80054, Amiens, France

    Estelle Josse & Momar Diouf

  5. Department of Cardiac Surgery, Amiens Picardy University Hospital, 80054, Amiens, France

    Gilles Touati

  6. Department of Cardiac Surgery, Dijon University Hospital, 14033, Dijon, France

    Olivier Bouchot

Authors
  1. Osama Abou-Arab
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  2. Pierre Huette
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  3. Lucie Martineau
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  4. Clémence Beauvalot
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  5. Christophe Beyls
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  6. Estelle Josse
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  7. Gilles Touati
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  9. Belaïd Bouhemad
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  10. Momar Diouf
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  11. Emmanuel Lorne
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  12. Pierre-Grégoire Guinot
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Contributions

OAA: study design, performing the procedure, writing the first manuscript and revising the manuscript; PH: study design, performing the procedure and revising the manuscript; PGG: study design, performing the procedure, and revising the manuscript; MD: statistical analysis; EL: study design and revising the manuscript; CB: performing the procedure; EJ: data collection; CB: performing the procedure; all the authors: revision and final approval of the version to be submitted.

Corresponding author

Correspondence to Osama Abou-Arab.

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Conflicts of interest

All authors report no conflict of interest.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and was approved by the local research ethics committee.

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Abou-Arab, O., Huette, P., Martineau, L. et al. Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: the CARDIOX randomized clinical trial. Intensive Care Med 45, 1413–1421 (2019). https://doi.org/10.1007/s00134-019-05761-4

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