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Lowest core body temperature and adverse outcomes associated with coronary artery bypass surgery

Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, Gordon.DeFoe{at}hitchcock.org

Charles F Krumholz

Fletcher Allen Health Care, Burlington, VT, USA

Christian P DioDato

Concord Hospital, Concord, NH, USA

Cathy S Ross

Dartmouth Medical School, Hanover, NH, USA

Elaine M Olmstead

Dartmouth Medical School, Hanover, NH, USA

Robert C Groom

Maine Medical Center, Portland, ME, USA

John W Pieroni

Catholic Medical Center, Manchester, NH, USA

Richard J Forest

Maine Medical Center, Portland, ME, USA

Brian R O’Connor

Beth Israel Deaconess Medical Center, Boston, MA, USA

Mary E Bogosian

University of Massachusetts Memorial Health Care Medical Center, Worcester, MA, USA

Craig S Warren

Eastern Maine Medical Center, Bangor, ME, USA

Gerald T O’Connor

Dartmouth Medical School, Hanover, NH, USA

For The Northern New England Cardiovascular Disease Study Group

To examine the effect of lowest core body temperature on adverse outcomes associated with coronary artery bypass graft (CABG) surgery, data were collected on 7134 isolated CABG procedures carried out in New England from 1997 to 2000. Excluded from the analysis were patients with pump times <60 and >120 min and those operated upon using continuous warm cardioplegia. Data for lowest core temperature were divided into quartiles for analysis (31.4°C, 31.5-33.1°C, 33.2-34.3°C, and 34.4°C).

Patients with lower core body temperature on cardio-pulmonary bypass (CPB) had higher in-hospital mortality rates. Crude mortality rates were 2.9% in the 31.4°C group, 2.1% in the 31.5 - 33.1°C group, 1.3% in the 33.2 - 34.3°C group and 1.2% in the 34.4°C group. The trend toward higher mortality as core temperature decreased was statistically significant (p_trend<0.001). Adjustment for differences in patient and disease characteristics did not significantly change the results and the test of trend remained significant (p<0.001).

Rates of perioperative stroke were somewhat lower in the colder groups. Rates in the two colder groups were0.9% compared with 1.6% and 1.4% in the warmer groups (p_trend = 0.082). This remained a marginal but significant trend after adjustment for possible confounding factors (p=0.044).

Low core body temperatures on CPB are associated with higher rates of in-hospital mortality among isolated CABG patients. Rates of intra- or postoperative use of an intra-aortic balloon pump are also higher with lower core temperatures. We concluded that temperature management strategy during CABG surgery has an important effect on patient outcomes.

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