Conservative Fluid Resuscitation Protocol Does Not Reduce the Incidence of Reoperation for Bleeding during the First 48 Hours after Emergency CABG

Abstract

Abstract BACKGROUND Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (CABG) has been identified as an independent risk factor for mortality with the incidence of in-hospital death ranging from 9–22%. A potential cause might be coagulopathy induced by dilution due to liberal fluid management. The aim of this study was to evaluate the effects of two volume resuscitation protocols on ROB after CABG.METHODS In this retrospective single-center study, all patients who underwent emergency CABG (n = 265) at our institution between 2011 and 2020 were included. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 hours after intensive care unit admission according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed.RESULTS The incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II and laboratory values. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables.CONCLUSIONS Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Ethics approval and consent to participate: This study has been approved by the Ethics Committee of Northwestern and Central Switzerland. (Project-ID: 2020 − 01833)Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study)