Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Med Intensiva 2018;42:159-67 - Vol. 42 Num.3 DOI: 10.1016/j.medine.2018.03.001
Original
Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study
Síndrome de bajo gasto cardiaco en el postoperatorio de cirugía cardiaca. Perfil, diferencias en evolución clínica y pronóstico. Estudio ESBAGA
J.L. Pérez Velaa,, , J.J. Jiménez Riverab, M.Á. Alcalá Llorentec, B. González de Marcosd, H. Torradoe, C. García Labordaf, M.D. Fernández Zamorag, F.J. González Fernándezh, J.C. Martín Benítezi, on behalf of the Grupo ESBAGA
a Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
c Servicio de Medicina Intensiva, Fundación Jiménez Díaz, Madrid, Spain
d Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain
e Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, Barcelona, Spain
f Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
g Servicio de Medicina Intensiva, Hospital Universitario Carlos Haya, Málaga, Spain
h Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
i Servicio de Medicina Intensiva, Hospital Clínico Universitario San Carlos, Madrid, Spain
Received 30 January 2017, Accepted 26 May 2017
Abstract
Objectives

An analysis is made of the clinical profile, evolution and differences in morbidity and mortality of low cardiac output syndrome (LCOS) in the postoperative period of cardiac surgery, according to the three diagnostic subgroups defined by the SEMICYUC Consensus 2012.

Design

A multicenter, prospective cohort study was carried out.

Setting

Intensive Care Units of Spanish hospitals with cardiac surgery.

Patients

A consecutive sample of 2070 cardiac surgery patients was included, with the analysis of 137 patients presenting LCOS.

Interventions

No.

Results

The mean patient age was 68.3±9.3 years (65.2% males), with a EuroSCORE II of 9.99±13. NYHA functional class III and IV (52.9%), left ventricular ejection fraction <35% (33.6%), acute myocardial infarction (31.9%), severe pulmonary hypertension (21.7%), critical preoperative condition (18.8%), prior cardiac surgery (18.1%), PTCA/stent placement (16.7%). According to subgroups, 46 patients fulfilled hemodynamic criteria of LCOS (group A), 50 clinical criteria of LCOS (group B), and the rest (n=41) presented cardiogenic shock (group C). Significant differences were observed over the evolutive course between the subgroups in terms of time subjected to mechanical ventilation (114.4, 135.4 and 180.3min in groups A, B and C, respectively; p<0.001), renal replacement requirements (11.4%, 14.6% and 36.6%; p=0.007), multiorgan failure (16.7%, 13% and 47.5%), and mortality (13.6%, 12.5% and 35.9%; p=0.01). The mean maximum lactate concentration was higher in cardiogenic shock patients (p=0.002).

Conclusions

The clinical evolution of these patients leads to high morbidity and mortality. Differences were found between the subgroups in terms of postoperative clinical course and mortality.

Resumen
Objetivos

Análisis del perfil clínico, la evolución y las diferencias en morbimortalidad en el síndrome de bajo gasto cardiaco (SBGC) en el postoperatorio de cirugía cardiaca, según los 3 subgrupos de diagnóstico definidos en el Consenso SEMICYUC 2012.

Diseño

Estudio de cohortes prospectivo multicéntrico.

Ámbito

UCI de hospitales españoles con cirugía cardiaca.

Pacientes

Muestra consecutiva de 2.070 pacientes intervenidos de cirugía cardiaca. Análisis de 137 pacientes con SBGC.

Intervenciones

No se realiza intervención.

Resultados

Edad 68,3±9,3 años, 65,2% varones, con un EuroSCORE II de 9,99±13. Los antecedentes a destacar fueron: NYHA III-IV (52,9%), FEVI<35% (33,6%), IAM (31,9%), HTP severa (21,7%), estado crítico preoperatorio (18,8%), cirugía cardiaca previa (18,1%) y ACTP/stent (16,7%). Según subgrupos, 46 pacientes cumplían criterios hemodinámicos de SBGC (grupo A), 50 criterios clínicos (grupo B) y el resto (n=41) fueron shock cardiogénico (grupo C). En la evolución, se encontraron diferencias significativas entre los subgrupos en el tiempo de ventilación mecánica (114,4, 135,4 y 180,3min, para A, B y C, respectivamente, p<0,001), la necesidad de reemplazo renal (11,4, 14,6 y 36,6%, p=0,007), el fracaso multiorgánico (16,7, 13 y 47,5%) y la mortalidad (13,6, 12,5 y 35,9%, p=0,01). La media de lactato máximo fue mayor en los pacientes con shock cardiogénico (p=0,002).

Conclusiones

La evolución clínica de estos pacientes con SBGC conlleva una elevada morbimortalidad. Encontramos diferencias entre los subgrupos en el curso clínico postoperatorio y la mortalidad.

Keywords
Low cardiac output syndrome, Cardiac surgery, Evolution, Prognosis, ESBAGA
Palabras clave
Síndrome de bajo gasto cardíaco, Cirugía cardíaca, Evolución, Pronóstico, ESBAGA

Article

To access the full text of the publication must be Medicina Intensiva subscriber or member of Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.

  • If you are a member of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias:
    Go to the members area of the website of the SEMICYUC (www.semicyuc.org )and click the link to the magazine.
  • If you are a subscriber:
    Can you recover your data in the "I forgot my password" located on the right sidebar of this website.

Med Intensiva 2018;42:159-67 - Vol. 42 Num.3 DOI: 10.1016/j.medine.2018.03.001
Cookies Policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.