BACKGROUND AND AIM OF THE STUDY: The objective of this randomized trial was to compare the efficacy of two strategies of hemodynamic management during cardiopulmonary bypass (CPB) on morbidity, mortality, cognitive complications and deterioration in functional status. METHODS:Patients scheduled to undergo primary elective CABG were eligible. In one group, mean arterial pressure target during CPB was 80 mmHg ("high" MAP group); in the other group, MAP target was determined by patients' pre-bypass MAP ("custom" MAP group). The principal outcomes were mortality, major neurologic or cardiac complications, cognitive complications or deterioration in functional status. RESULTS: Of 412 enrolled patients, 36% were women, with overall mean age of 64.7 +/- 12.3 years. Duration of bypass was identical for the two randomization groups. Overall complication rates were similar: 16.5% of the high group and 14.6% of the custom group experienced one or more neurologic, cardiac or cognitive complications. When only cardiac and neurologic morbidity and mortality were considered, the rates were 11.7% and 12.6%, in the high and custom groups, respectively. The aggregate outcome rate, including functional deterioration, was 31.6% in the high group and 29.6% in the custom group. CONCLUSIONS: There were no statistically significant differences between the high MAP group and the custom MAP group for the combined outcome of mortality cardiac, neurologic or cognitive complications, and deterioration in the quality of life.
RCT Entities:
BACKGROUND AND AIM OF THE STUDY: The objective of this randomized trial was to compare the efficacy of two strategies of hemodynamic management during cardiopulmonary bypass (CPB) on morbidity, mortality, cognitive complications and deterioration in functional status. METHODS:Patients scheduled to undergo primary elective CABG were eligible. In one group, mean arterial pressure target during CPB was 80 mmHg ("high" MAP group); in the other group, MAP target was determined by patients' pre-bypass MAP ("custom" MAP group). The principal outcomes were mortality, major neurologic or cardiac complications, cognitive complications or deterioration in functional status. RESULTS: Of 412 enrolled patients, 36% were women, with overall mean age of 64.7 +/- 12.3 years. Duration of bypass was identical for the two randomization groups. Overall complication rates were similar: 16.5% of the high group and 14.6% of the custom group experienced one or more neurologic, cardiac or cognitive complications. When only cardiac and neurologic morbidity and mortality were considered, the rates were 11.7% and 12.6%, in the high and custom groups, respectively. The aggregate outcome rate, including functional deterioration, was 31.6% in the high group and 29.6% in the custom group. CONCLUSIONS: There were no statistically significant differences between the high MAP group and the custom MAP group for the combined outcome of mortality cardiac, neurologic or cognitive complications, and deterioration in the quality of life.
Authors: Charlotte C McEwen; Takhliq Amir; Yuan Qiu; Jack Young; Kevin Kennedy; Hilary P Grocott; Hessam Kashani; David Mazer; Scott Brudney; Morvarid Kavosh; Eric Jacobsohn; Anne Vedel; Eugene Wang; Richard P Whitlock; Emilie P Belley-Coté; Jessica Spence Journal: Can J Anaesth Date: 2022-01-10 Impact factor: 6.713
Authors: David L McDonagh; Miles Berger; Joseph P Mathew; Carmelo Graffagnino; Carmelo A Milano; Mark F Newman Journal: Lancet Neurol Date: 2014-04-02 Impact factor: 44.182
Authors: Sebastian Wiberg; Frederik Holmgaard; Kaj Blennow; Jens C Nilsson; Jesper Kjaergaard; Michael Wanscher; Annika R Langkilde; Christian Hassager; Lars S Rasmussen; Henrik Zetterberg; Anne Grønborg Vedel Journal: Interact Cardiovasc Thorac Surg Date: 2021-01-22
Authors: Xiaopeng Zhang; Xiaowei Yan; Jennifer Gorman; Stuart N Hoffman; Li Zhang; Joseph A Boscarino Journal: Neuropsychiatr Dis Treat Date: 2014-02-19 Impact factor: 2.570