Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-Directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial

Purpose

Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery.

Materials and Methods

Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65– 90 mmHg; central venous pressure 8– 12 mmHg; urine output ≥ 0.5 mL·kg^{− 1}·h^{− 1}; oxygen saturation > 95%; and hematocrit 26– 30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation < 13%; stroke volume index 33– 65 mL·beat^{− 1}·m^{− 2}; cardiac index 2.2– 4.0 L·min^{− 1}·m^{− 2}; and systemic vascular resistance index 1600– 2500 dynes·s·cm^-5·m^-2.

Results

The intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference − 29.5 h; 95% CI − 17.2 to − 41.8, P < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference − 11.3 h; 95% CI − 2.7 to − 19.9, P = 0.011). The hospital LOS was shorter in the EGDT group (mean difference − 1.1 d; 95% CI − 0.1 to − 2.1, P = 0.038).

Conclusion

EGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.