Department of Anesthesiology

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The efficacy and safety of a pharmacologic protocol for maintaining coronary artery bypass patients at a higher mean arterial pressure during cardiopulmonary bypass.

TitleThe efficacy and safety of a pharmacologic protocol for maintaining coronary artery bypass patients at a higher mean arterial pressure during cardiopulmonary bypass.
Publication TypeJournal Article
Year of Publication1998
AuthorsPirraglia PA, Peterson JC, Hartman GS, Yao FS, Thomas SJ, Charlson ME
JournalJ Extra Corpor Technol
Volume30
Issue2
Pagination64-72
Date Published1998 Jun
ISSN0022-1058
KeywordsAged, Anesthetics, Intravenous, Blood Pressure, Cardiopulmonary Bypass, Coronary Artery Bypass, Female, Fentanyl, Heart, Humans, Incidence, Intensive Care, Intubation, Intratracheal, Length of Stay, Male, Nervous System, Nitroglycerin, Nitroprusside, Phenylephrine, Postoperative Hemorrhage, Renal Insufficiency, Safety, Stroke Volume, Treatment Outcome, Vasoconstrictor Agents, Vasodilator Agents
Abstract

A recent randomized trial of higher versus lower mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) showed that higher MAP on CPB was associated with a lower incidence of overall cardiac and neurologic morbidity and mortality in coronary artery bypass graft surgery (CABG) patients. Cardiopulmonary bypass MAP was controlled pharmacologically while CPB flow was held constant for any given period. The objective of the present study was to assess the efficacy and safety of this pharmacologic protocol. Two hundred forty-eight patients participated in the study; the mean age was 65.8 +/- 9.4 years, 20% were women, and the mean preoperative ejection fraction was 48%. The low-flow corrected CPB MAP attained for the low and high MAP groups was 56.7 +/- 5.0 mmHg and 77.7 +/- 7.1 mmHg, respectively (p = 0.0001). Major cardiac and neurologic outcomes, postoperative blood loss, renal dysfunction, intensive care unit (ICU) stay, and duration of intubation were not found to be significantly associated with any drug in the pharmacologic protocol. These findings support that the pharmacologic protocol used to maintain CABG patients at higher MAP on CPB is both efficacious and safe.

Alternate JournalJ Extra Corpor Technol
PubMed ID10182115
Grant ListHL44719 / HL / NHLBI NIH HHS / United States