Yang
Pre-conditioning with HBO may induce cerebral and cardiac protection in patients undergoing on-pump CABG surgery
Clinical Bottom line:
1. Pre-conditioning with HBO resulted in improved clinical outcomes for patients undergoing 'on-pump' CABG surgery.
2. There were also potential cerebral and cardiac protective effects as determined by proxy outcomes.
3. No protective effects were noted in off-pump CABG
Citation/s:Yang L, Dong H, Chen M et al. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. Journal of Cardiothoracic and Vascular Anesthesia 2011;25(6):908-916.
Lead author's name and email:Yang Li: lxiong@fmmu.edu.cn
Three-part Clinical Question:For patients undergoing CABG, does the addition of hyperbaric oxygen to standard care confer any myocardial and cerebral protection?
Search Terms:CABG, preconditioning, cardiopulmonary bypass
The Study:Single-blinded randomised controlled trial without intention-to-treat.
The Study Patients:Male patients under 80 years having CAG either on cardiopulmonary bypass or off-pump.
Control group(N = 16; 15 analysed): Full orthodox pre-operative care for CABG. No sham treatment.
Experimental group(N = 15; 14 analysed): As above, but patients were given 5 daily sessions of HBOT at 2ATA breathing 100% ATA for 70 minutes.
The Evidence:
|
Outcome |
Control Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Length of ICU Stay in on-pump patients (hrs) |
85.9 |
40.3 |
59.4 |
20.9 |
26.5 |
1.8 to 51.2 |
|
Serum S100B concentration of on-pump patients at time of ICU arrival (pg/ml) |
89.7 |
14.6 |
60.4 |
26.4 |
29.3 |
13.2 to 45.4 |
|
Serum NSE concentration of on-pump patients at 24hrs post-op (ng/ml) |
38.0 |
8.4 |
30.3 |
6.1 |
7.7 |
2.1 to 13.3 |
Comments:
1. Exclusion of female subjects and small numbers may limit external validity of the study
2. Only 2 biochemical markers were analyzed to measure cerebral injury; it may not be fully representative of actual cerebral damage.
3. Early post-operative outcomes may not be representative of long-term morbidity and mortality
4. Values of mean and standard deviation were not provided for non-significant results in off-pump patients.
Appraised by:Bryan Hui and Michael Bennett, Tuesday, 23 April 2013
Email:bryan.hui@student.unsw.edu.au
Kill or Update By: April 2024
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