Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-Directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial.

Abstract

PurposeEarly goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery.Patients and MethodsEighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg−1·h−1; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33–65 mL·beat−1·m−2; cardiac index 2.2–4.0 L·min−1·m−2; and systemic vascular resistance index 1600–2500 dynes·s·cm-5·m-2.ResultsThe intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference −29.5 h; 95% CI −17.2 to −41.8, P < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference −11.3 h; 95% CI −2.7 to −19.9, P = 0.011). The hospital LOS was shorter in the EGDT group (mean difference −1.1 d; 95% CI −0.1 to −2.1, P = 0.038).ConclusionEGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.