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High-Target vs Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients - A Randomized Controlled Trial

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@article{6ce7d15f183e4c0b82d2a410d87b2266,
title = "High-Target vs Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients - A Randomized Controlled Trial",
abstract = "Background -Cerebral injury is an important complication following cardiac surgery with the use of cardiopulmonary bypass (CPB). The rate of overt stroke after cardiac surgery is 1-2%, whereas silent strokes, detected by diffusion-weighed magnetic resonance imaging (DWI), are found in up to 50% of patients. It is unclear if a higher versus a lower blood pressure during cardiopulmonary bypass reduces cerebral infarction in these patients. Methods -In a patient- and assessor-blinded randomized trial, we allocated patients to a higher (70-80 mmHg) or lower (40-50 mmHg) target for mean arterial pressure by the titration of norepinephrine during cardiopulmonary bypass. Pump flow was fixed at 2.4 L/min/m2. The primary outcome was the total volume of new ischemic cerebral lesions (sum in mm3), expressed as the difference between DWI conducted preoperatively and again postoperatively between day 3 and 6. Secondary outcomes included DWI-evaluated total number of new ischemic lesions. Results -Among the 197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4 (8.9) years in the high-target group (n=98). Procedural risk scores were comparable between groups. Overall, DWI revealed new cerebral lesions in 52.8% of patients in the low-target group versus 55.7% in the high-target group (p = 0.76). The primary outcome of volume of new cerebral lesions was comparable between groups, 25 mm3 (interquartile range [IQR], 0-118; range 0-25261) in the low-target group vs 29 mm3 (IQR 0-143; range 0-22116) in the high-target group (median difference estimate, 0 (95% confidence interval [95% CI] -25 - 0.028); P=0.99), as was the secondary outcome of number of new lesions (1 (IQR 0-2; range 0-24) vs 1 (IQR 0-2; range 0-29) respectively; median difference estimate, 0 (95% CI 0 - 0); P=0.71). No significant difference was observed in frequency of severe adverse events. Conclusions -Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower MAP during cardiopulmonary bypass did not seem to affect the volume or numbers of new cerebral infarcts. Clinical Trial Registration -URL: http://www.clinicaltrials.gov Unique identifier: NCT02185885.",
keywords = "Journal Article",
author = "Vedel, {Anne G} and Frederik Holmgaard and Rasmussen, {Lars S} and Annika Langkilde and Paulson, {Olaf B} and Theis Lange and Carsten Thomsen and Olsen, {Peter Skov} and Ravn, {Hanne Berg} and Nilsson, {Jens C}",
year = "2018",
doi = "10.1161/CIRCULATIONAHA.117.030308",
language = "English",
volume = "137",
pages = "1770--1780",
journal = "Circulation (Baltimore)",
issn = "0009-7322",
publisher = "Lippincott Williams & Wilkins",
number = "17",

}

RIS

TY - JOUR

T1 - High-Target vs Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients - A Randomized Controlled Trial

AU - Vedel, Anne G

AU - Holmgaard, Frederik

AU - Rasmussen, Lars S

AU - Langkilde, Annika

AU - Paulson, Olaf B

AU - Lange, Theis

AU - Thomsen, Carsten

AU - Olsen, Peter Skov

AU - Ravn, Hanne Berg

AU - Nilsson, Jens C

PY - 2018

Y1 - 2018

N2 - Background -Cerebral injury is an important complication following cardiac surgery with the use of cardiopulmonary bypass (CPB). The rate of overt stroke after cardiac surgery is 1-2%, whereas silent strokes, detected by diffusion-weighed magnetic resonance imaging (DWI), are found in up to 50% of patients. It is unclear if a higher versus a lower blood pressure during cardiopulmonary bypass reduces cerebral infarction in these patients. Methods -In a patient- and assessor-blinded randomized trial, we allocated patients to a higher (70-80 mmHg) or lower (40-50 mmHg) target for mean arterial pressure by the titration of norepinephrine during cardiopulmonary bypass. Pump flow was fixed at 2.4 L/min/m2. The primary outcome was the total volume of new ischemic cerebral lesions (sum in mm3), expressed as the difference between DWI conducted preoperatively and again postoperatively between day 3 and 6. Secondary outcomes included DWI-evaluated total number of new ischemic lesions. Results -Among the 197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4 (8.9) years in the high-target group (n=98). Procedural risk scores were comparable between groups. Overall, DWI revealed new cerebral lesions in 52.8% of patients in the low-target group versus 55.7% in the high-target group (p = 0.76). The primary outcome of volume of new cerebral lesions was comparable between groups, 25 mm3 (interquartile range [IQR], 0-118; range 0-25261) in the low-target group vs 29 mm3 (IQR 0-143; range 0-22116) in the high-target group (median difference estimate, 0 (95% confidence interval [95% CI] -25 - 0.028); P=0.99), as was the secondary outcome of number of new lesions (1 (IQR 0-2; range 0-24) vs 1 (IQR 0-2; range 0-29) respectively; median difference estimate, 0 (95% CI 0 - 0); P=0.71). No significant difference was observed in frequency of severe adverse events. Conclusions -Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower MAP during cardiopulmonary bypass did not seem to affect the volume or numbers of new cerebral infarcts. Clinical Trial Registration -URL: http://www.clinicaltrials.gov Unique identifier: NCT02185885.

AB - Background -Cerebral injury is an important complication following cardiac surgery with the use of cardiopulmonary bypass (CPB). The rate of overt stroke after cardiac surgery is 1-2%, whereas silent strokes, detected by diffusion-weighed magnetic resonance imaging (DWI), are found in up to 50% of patients. It is unclear if a higher versus a lower blood pressure during cardiopulmonary bypass reduces cerebral infarction in these patients. Methods -In a patient- and assessor-blinded randomized trial, we allocated patients to a higher (70-80 mmHg) or lower (40-50 mmHg) target for mean arterial pressure by the titration of norepinephrine during cardiopulmonary bypass. Pump flow was fixed at 2.4 L/min/m2. The primary outcome was the total volume of new ischemic cerebral lesions (sum in mm3), expressed as the difference between DWI conducted preoperatively and again postoperatively between day 3 and 6. Secondary outcomes included DWI-evaluated total number of new ischemic lesions. Results -Among the 197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4 (8.9) years in the high-target group (n=98). Procedural risk scores were comparable between groups. Overall, DWI revealed new cerebral lesions in 52.8% of patients in the low-target group versus 55.7% in the high-target group (p = 0.76). The primary outcome of volume of new cerebral lesions was comparable between groups, 25 mm3 (interquartile range [IQR], 0-118; range 0-25261) in the low-target group vs 29 mm3 (IQR 0-143; range 0-22116) in the high-target group (median difference estimate, 0 (95% confidence interval [95% CI] -25 - 0.028); P=0.99), as was the secondary outcome of number of new lesions (1 (IQR 0-2; range 0-24) vs 1 (IQR 0-2; range 0-29) respectively; median difference estimate, 0 (95% CI 0 - 0); P=0.71). No significant difference was observed in frequency of severe adverse events. Conclusions -Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower MAP during cardiopulmonary bypass did not seem to affect the volume or numbers of new cerebral infarcts. Clinical Trial Registration -URL: http://www.clinicaltrials.gov Unique identifier: NCT02185885.

KW - Journal Article

U2 - 10.1161/CIRCULATIONAHA.117.030308

DO - 10.1161/CIRCULATIONAHA.117.030308

M3 - Journal article

C2 - 29339351

VL - 137

SP - 1770

EP - 1780

JO - Circulation (Baltimore)

JF - Circulation (Baltimore)

SN - 0009-7322

IS - 17

ER -

ID: 52537996