Yogaratnam

HBOT preconditioning prior to first time elective CABG improved intraoperative blood loss and reduced ICU stay.

Clinical Bottom Line:

1. Pre-treating elective CBP CABG patients with HBO resulted in reduced intra-operative blood loss and ICU stay. 2. Cardiac function post operatively may be improved and there may be improved cardioprotection from ischaemia- reperfusion injury

Citations: 1. Yogaratnam JZ, Laden G, Madden LA, Guvendik L, Cowen M, Greenman M, Seymour AM, Cale A, Griffin S. Hyperbaric oxygen preconditioning promotes cardioprotection following ischemic reperfusion injury by improving myocardial function, limiting necrosis and enhancing the induction of Hsp72. Undersea and Hyperbaric Medicine 2007; 34(4):301-302

2. Yogaratnam J, Laden G, Guvendik L, Cowen M, Cale A, Griffin S. Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. Cardiovascular Revascularization Medicine: Including Molecular Interventions 2010;11(1):8-19.

3. Jeysen ZY, Gerard L, Levant G, Cowen M, Cale A, Griffin S. Research report: the effects of hyperbaric oxygen preconditioning on myocardialbiomarkers of cardioprotection in patients having coronary artery bypass graft surgery. Undersea Hyperb Med. 2011 May-Jun;38(3):175-85 

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Lead author's name and contact: Jeysen Yogaratnam jeysenzy@msn.com

Three-part Clinical Question:For patients about to undergo on-pump coronary artery bypass grafting, does pre-operative HBOT improve outcomes?

Search Terms: Coronary artery bypass graft; cardiopulmonary bypass

The Study: Single-blinded randomised controlled trial with intention-to-treat.

The Study Patients: First time elective CABG using CPB and with an ejection fraction >30%.

Control group (N = 40; 40 analysed): No specific intervention

Experimental group (N = 41; 41 analysed): On the day of surgery, 100% oxygen at 2.4ATA for 60 minutes 4 hours prior to procedure.

The Evidence:

Measure	Control Group		HBO Group		Difference	95% CI
Stroke Volume 24 hours postop. (mls)	Mean	SD	Mean	SD
	63.1	13.9	74.6	19.7	11.5	-156 to 179

 

Non-Event Outcomes	Control group mean	Experimental group mean	P-value
ICU stay in hours	1051	850	0.05
Intraoperative blood loss (mean in ml)	309	133	0.02

 

Comments:

1. Other findings were not statistically significant but tended towards a more favourable outcome in the HBO group.

2. Only 25 control and 22 intervention patients (58%) had haemodynamic studies due to lack of equipment. Bias may have been towards monitoring the more unwell patients in each group.

3. The exclusion criteria removed the most at risk patients, so these results apply to low risk patients.

4. Cost analysis conducted by the study found a saving of US $582.5 per HBOT patient in the intervention group based on a comparison of ICU bed cost and HBOT cost.

5. Third citation documented lower levels of eNOS and heat shock protein 72 (HSP72) within myocardial cells after induction and during CPB, but an increase after the period of ischaemia, This may imply an increase in endogenous myocardial protection.

Appraised by:Nicholas Titheridge HMAS PENGUIN, SUMU-E; Monday, 4 June 2018. Third citation by M Bennett May 2019.

Email: ntitheridge@gmail.com

Kill or Update By: June 2024

 

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