Predictive value of ScvO2 monitoring for pericardial tamponade after cardiac surgery.

Abstract

We examined the predictive value of central venous oxygen saturation (ScvO2) changes regarding the occurrence of pericardial tamponade following cardiac surgery. We retrospectively identified 66consecutive patients in whom ScvO2 and arterial lactate levels were analyzed during an 8‑h time interval preceding pericardiotomy due to pericardial tamponade (PT), and at equivalent time points in 30control patients(C) who had an uncomplicated course. The median age of the patients was 74years (interquartile range, 63-78). Three percent of procedures were re-operations. There were no differences between the baseline values of PT andC patients. Pericardiotomy was performed on average 1day (0-3.5) after cardiac surgery. PT patients displayed asignificant decline (p< 0.001) to lower ScvO2 levels (p< 0.001) and asignificant increase (p= 0.005) to higher arterial lactate levels (p= 0.019) during the 8 h preceding pericardiotomy, whereas Cpatients did not (p= 0.440 and p= 0.279, respectively). PT was associated with alonger hospital stay (p= 0.04) and ahigher in-hospital mortality (p= 0.008). AnScvO2 decline below 60% (p= 0.018), adelta ScvO2 decline greater than 5% (p= 0.001), and adelta lactate increase greater than 0.18 mmol/l (p= 0.002) during the 8 h preceding pericardiotomy were independently associated with PT. None of these parameters predicted in-hospital mortality. Deteriorations in ScvO2 might serve as an early marker of PT following cardiac surgery.