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Emergency cardiac mechanical assistance: place of mucosal gastric tonometry as prognostic indicator*

Published online by Cambridge University Press:  01 October 2007

P. Rosamel ,
C. Flamens ,
S. Paulus ,
M. Cannesson  and
O. Bastien
P. Rosamel
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
C. Flamens
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
S. Paulus
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
M. Cannesson
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
O. Bastien*
Affiliation:
Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France
*
Correspondence to: Olivier Bastien, Service d’Anesthésie et Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, 69394 Lyon, France. E-mail: olivier.bastien@chu-lyon.fr; Tel: +472118932; Fax: +472357314
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Summary

Background and objectives

The death of patients treated by ventricular assist device is usually related to multiorgan failure for which a disorder of splanchnic circulation is blamed. Gastric tonometry (measurement of gastric intra-mucosal pressure of CO2) has already been studied in many fields and especially in cardiac surgery. The aim of this study was to investigate the prognostic value of gastric tonometry monitoring after implantation of a ventricular assist device.

Methods

In this prospective study, all consecutive patients scheduled for a ventricular assist device were included. Gastric tonometry was added to standard monitoring. Data were collected (lactate, gastric CO2 (PgCO2) during cardiopulmonary bypass, at admission to ICU, 24 and 48 h later and when norepinephrine was stopped. Preoperative biologic and haemodynamic data were also collected. The primary endpoint was death.

Results

Fifty-six patients (50 men and 6 women) were included. In 91% of the cases, the mechanical assistance was biventricular. The objective of the assistance was a bridge to transplant in 93% (n = 27). Twenty-seven deaths (48%) occurred during the study, 59% (n = 16) of them took place before the cardiac transplantation (mean time = 18 ± 16 days after assist device insertion). Many factors were found to be associated with death: weight (P = 0.018), red cells administration (P = 0.025), length of surgery (P = 0.016), PgCO2 on admission to ICU (P = 0.040) and norepinephrine dose at 24 h.

Conclusions

Gastric tonometry has a prognostic value in the early postoperative hours after the implantation of a ventricular assist device.

Keywords

CARDIOPULMONARY BYPASSHEART-ASSIST DEVICESSTOMACH, gastric tonometryMORTALITYTRANSPLANTATION HEARTSPLANCHNIC CIRCULATION
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 840 - 846
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

*

This work was presented at the ‘46th Congrès de réanimation de langue française’ in Paris, April 2004 (R149) and at ‘Euroanesthesia’ Joint Meeting of European Society of Anaesthesiologists and European Acadamy of Anaesthesiology, Lisbon Portugal June 2004.

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