Introduction:

A high-pressure excursion (HPE) is a sudden increase in oxygenator inlet pressure during cardiopulmonary bypass (CPB). The aims of this study were to identify factors associated with HPE, to describe a treatment protocol utilizing epoprostenol in severe cases, and to assess early outcome in HPE patients.

Methods:

Patients who underwent cardiac surgery with cardiopulmonary bypass at Sahlgrenska University Hospital 2016–2018 were included in a retrospective observational study. Pre- and post-operative data collected from electronic health records, local databases, and registries were compared between HPE and non-HPE patients. Factors associated with HPE were identified with logistic regression models.

Results:

In total, 2024 patients were analyzed, and 37 (1.8%) developed HPE. Large body surface area (adjusted Odds Ratio (aOR): 1.43 per 0.1 m²; 95% confidence interval (CI): 1.16–1.76, p < 0.001), higher hematocrit during CPB (aOR: 1.20 per 1%; (1.09–1.33), p < 0.001), acute surgery (aOR: 2.98; (1.26–6.62), p = 0.018), and previous stroke (aOR: 2.93; (1.03–7.20), p = 0.027) were independently associated with HPE. HPE was treated with hemodilution (n = 29, 78.4%), and/or extra heparin (n = 23, 62.2%), and/or epoprostenol (n = 12, 32.4%). No oxygenator change-out was necessary. While there was no significant difference in 30-day mortality (2.7% vs 3.2%, p = 1.0), HPE was associated with a higher perioperative stroke rate (8.1% vs 1.8%, aOR 5.09 (1.17–15.57), p = 0.011).

Conclusions:

Large body surface area, high hematocrit during CPB, previous stroke and acute surgery were independently associated with HPE. A treatment protocol including epoprostenol appears to be a safe option. Perioperative stroke rate was increased in HPE patients.

中文翻译：

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体外循环中氧合器高压漂移的危险因素及处理

介绍：

高压偏移 (HPE) 是体外循环 (CPB) 期间氧合器入口压力的突然增加。本研究的目的是确定与 HPE 相关的因素，描述在严重病例中使用依前列醇的治疗方案，并评估 HPE 患者的早期结果。

方法：

一项回顾性观察研究纳入了 2016-2018 年在萨尔格伦斯卡大学医院接受体外循环心脏手术的患者。从电子健康记录、本地数据库和登记处收集的术前和术后数据在 HPE 和非 HPE 患者之间进行了比较。与 HPE 相关的因素通过逻辑回归模型确定。

结果：

总共分析了 2024 名患者，其中 37 名 (1.8%) 发生了 HPE。体表面积大（调整后的比值比 (aOR)：1.43/0.1 m ²；95% 置信区间 (CI)：1.16–1.76，p < 0.001），CPB 期间血细胞比容较高（aOR：1.20/1%；（1.09– 1.33)、p < 0.001)、急性手术 (aOR: 2.98; (1.26–6.62), p = 0.018) 和既往卒中 (aOR: 2.93; (1.03–7.20), p = 0.027) 与 HPE 独立相关。HPE 接受血液稀释（n = 29, 78.4%）和/或额外肝素（n = 23, 62.2%）和/或依前列醇（n= 12, 32.4%)。无需更换氧合器。虽然 30 天死亡率没有显着差异（2.7% 对 3.2%，p = 1.0），但 HPE 与较高的围手术期卒中发生率相关（8.1% 对 1.8%，aOR 5.09 (1.17–15.57)，p = 0.011 ).

结论：

大体表面积、CPB 期间高血细胞比容、既往中风和急性手术与 HPE 独立相关。包括依前列醇在内的治疗方案似乎是一种安全的选择。HPE 患者的围手术期卒中发生率增加。