Vol. 49 | No. 2 | July-December 2021 Back

Open Access

Association of Intraoperative Factors with Difficult Weaning from Cardiopulmonary Bypass Among Patients with Preserved Left Ventricular Ejection Fraction Who Underwent Coronary Artery Bypass Grafts

Meludee Joy Roche, Florian Nuevo
Dec 2021 DOI 10.69944/pjc.c6d15dfe42

Abstract

OBJECTIVE: To determine the incidence and the associated intraoperative factors that  contribute to difficult weaning from cardiopulmonary bypass (CPB) among coronary artery  bypass graft (CABG) patients with preserved left ventricular ejection fraction (LVEF). 

METHODS: This study was a prospective observational cohort study conducted at a specialty  center from September 1, 2019, to May 15, 2020. It included adult patients diagnosed with  coronary artery disease (CAD) admitted for elective CABG under the CABG Z-Benefit Package,  with an LVEF of greater than 50%. After institutional review board approval, data on consecutive  patients scheduled for elective, isolated CABG and meeting the inclusion criteria were  prospectively collected and analyzed. Descriptive or qualitative statistics was used to summarize  the demographic and clinical characteristics of the patients.  

RESULTS: Data from 52 patients who met the inclusion criteria were included in the analysis,  with 17.3% (n = 9/52) meeting the criteria for difficult weaning from CPB. Of these nine patients,  nine (100%) required use of more than one inotrope and/or vasopressor, and two of the nine  (22.22%) needed to return to CPB after coming off. Of those patients with nondifficult weaning  from CPB, 74.44% (n = 32/43) used a single inotrope, and 42.26% (n = 11/43) successfully  separated from CPB without any need for pharmacological support. Among the various  parameters assessed, logistic regression analysis showed that every unit increase in base deficit  after release of aortic cross-clamp increased the odds of having difficult separation from CPB  by 40.21%. Patients who received nicardipine were also 7.8 times more likely to have difficult  separation from CPB. 

CONCLUSION: In this study of patients with preserved left ventricular function undergoing  CABG surgery, we identified two intraoperative variables associated with difficult weaning from  CPB: (1) base deficit at release of aortic cross-clamp and (2) the use of nicardipine infusion.

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