Objective:

Compare the use of blood products and intravenous fluid management in patients scheduled for coronary artery bypass surgery and randomized to minimal invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC).

Methods:

A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC groups. The study period was the first 84 hours after surgery. Hemoglobin <80 g/l was used as transfusion trigger.

Results:

Red blood cell transfusions intraoperatively were given less often in the MiECC group (23.3% vs 9.2%, p = 0.005) and the total intravenous fluid intake was significantly lower in the MiECC group (3300 ml [2950–4000] vs 4800 ml [4000–5500], p < 0.001). Hemoglobin drop also was lower in the MiECC group (35.5 ± 8.9 g/l vs 50.7 ± 9 g/l, p < 0.001) as was hemoglobin drop percent (25.3 ± 6% vs 35.3 ± 5.9%, p < 0.001). Chest tube drainage output was higher in the MiECC group (645 ml [500–917.5] vs 550 ml [412.5–750], p = 0.001). Particularly, chest tube drainage in up to 600 ml category, was in benefit of CECC group (59.1% vs 40.8%, p = 0.003). ROC curve analysis showed that patients with hemoglobin level below 95 g/l upon arrival to intensive care unit was associated with increased risk of developing postoperative atrial fibrillation (POAF) (p = 0.002, auc = 0.61, cutoff <95, sensitivity = 0.47, positive predictive value = 0.64).

Conclusion:

MiECC reduced the intraoperative need for RBC transfusion and intravenous fluids compared to the CECC group, also reducing hemoglobin drop compared to the CECC group in CABG surgery patients. Postoperative hemoglobin drop was a predictor of POAF.

中文翻译：

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微创体外循环对冠状动脉搭桥手术围手术期静脉液体管理的影响

客观的：

比较计划进行冠状动脉搭桥手术并随机分配至微创体外循环 (MiECC) 和常规体外循环 (CECC) 的患者血液制品的使用和静脉输液管理。

方法：

共有 240 名计划进行首次体外循环 CABG 的患者被随机分配到 MiECC 或 CECC 组。研究时间为手术后的第一个 84 小时。血红蛋白 <80 g/l 被用作输血触发因素。

结果：

MiECC 组术中红细胞输注频率较低（23.3% 对 9.2%，p = 0.005），并且 MiECC 组的静脉输液总量明显较低（3300 毫升 [2950–4000] 对 4800 毫升 [4000] –5500]，p < 0.001）。MiECC 组的血红蛋白下降也较低（35.5 ± 8.9 g/l 对 50.7 ± 9 g/l，p < 0.001），血红蛋白下降百分比也较低（25.3 ± 6% 对 35.3 ± 5.9%，p < 0.001）。MiECC 组的胸管引流量更高（645 毫升 [500–917.5] 对比 550 毫升 [412.5–750]，p = 0.001）。特别是，高达 600 毫升类别的胸管引流对 CECC 组有益（59.1% 对 40.8%，p = 0.003）。

结论：

与 CECC 组相比，MiECC 减少了术中对红细胞输注和静脉输液的需求，与 CECC 组相比，CABG 手术患者的血红蛋白下降也减少了。术后血红蛋白下降是 POAF 的预测指标。