Abstract：
BACKGROUND: While newer heater-cooler technologies using ethylene glycol-based (GB) solutions during cardiothoracic surgery have become commercially available, there is a paucity of clinical data describing their effectiveness during cardiopulmonary bypass (CPB) support. This analysis aimed to compare clinical characteristics and procedural outcomes using water-based (WB) and GB heater-cooler systems.
METHODS: A retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS).
RESULTS: There were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different.
CONCLUSIONS: Our analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.
METHODS: A retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS).
RESULTS: There were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different.
CONCLUSIONS: Our analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.
摘要：
背景：尽管在心胸外科手术中使用基于乙二醇（GB）的解决方案的较新的加热器-冷却器技术已成为市售产品，缺乏描述其在体外循环(CPB)支持期间的有效性的临床数据.此分析旨在比较使用水基（WB）和GB加热器-冷却器系统的临床特征和手术结果。
方法：对2022年6月至10月接受CPB的连续成年患者进行回顾性分析，比较WB或GB组。主要结局是手术死亡或主要发病率的复合。次要终点包括CPB的输血要求，患者降温和升温速率，和病例完成时的血管活性-正性肌力评分（VIS）。使用P控制图来监测复合结局的每周发生率。进行子分析以评估由胸外科医师协会（STS）索引的心脏手术病例的主要结局。
结果：纳入167例患者进行分析；87例（52.1%）采用WB系统进行CPB，80例（47.9%）采用GB系统进行CPB。GB手术受试者较年轻(p=0.01)，经历了更长的CPB时间(p=.034)，并且更可能接受胸部移植或主动脉手术（p=0.015）。WB和GB组的手术死亡率或主要发病率的复合结局分别为29.9%和24%。分别（p=.372）。P控制图显示，在世界银行实践期间，每周平均发生率为30%，随着GB的实践，这一比例降至24%。在106例STS索引的心脏手术病例中，在我们的GB过渡后,平均复合结局发生率从19%下降至6%.此外,冷却,病例完成时,以患者BSA和VIS为指标的加温率无显著差异.
结论：我们的分析表明，在我们的实践中，从WB到GB加热器-冷却器技术的安全过渡。这项早期分析表明，可以安全地采用GB加热器冷却器来减轻心脏外科手术患者非结核分枝杆菌感染的风险。
方法：对2022年6月至10月接受CPB的连续成年患者进行回顾性分析，比较WB或GB组。主要结局是手术死亡或主要发病率的复合。次要终点包括CPB的输血要求，患者降温和升温速率，和病例完成时的血管活性-正性肌力评分（VIS）。使用P控制图来监测复合结局的每周发生率。进行子分析以评估由胸外科医师协会（STS）索引的心脏手术病例的主要结局。
结果：纳入167例患者进行分析；87例（52.1%）采用WB系统进行CPB，80例（47.9%）采用GB系统进行CPB。GB手术受试者较年轻(p=0.01)，经历了更长的CPB时间(p=.034)，并且更可能接受胸部移植或主动脉手术（p=0.015）。WB和GB组的手术死亡率或主要发病率的复合结局分别为29.9%和24%。分别（p=.372）。P控制图显示，在世界银行实践期间，每周平均发生率为30%，随着GB的实践，这一比例降至24%。在106例STS索引的心脏手术病例中，在我们的GB过渡后,平均复合结局发生率从19%下降至6%.此外,冷却,病例完成时,以患者BSA和VIS为指标的加温率无显著差异.
结论：我们的分析表明，在我们的实践中，从WB到GB加热器-冷却器技术的安全过渡。这项早期分析表明，可以安全地采用GB加热器冷却器来减轻心脏外科手术患者非结核分枝杆菌感染的风险。
