Continuous renal replacement therapy and mild hypothermia for acute severe left heart failure after cardiovascular surgery / 解放军医学杂志

ABSTRACT

Objective To explore the effect of continuous renal replacement therapy (CRRT) combined with mild hypothermia (MHT) on acute severe heart failure after cardiovascular surgery. Methods A retrospective analysis was performed of 26 patients who were treated from January 2007 to January 2015 with the combined therapy of CRRT and MHT (CRRT/ MHT). Core temperature was reduced to 34 ℃. The doses of inotropes and vasopressors decreased. Mean arterial pressure (MAP) was maintained at 60-70 mmHg and cardiac index (CI) >1.5 L/(min·m2). When cardiac function was improved core temperature was recovered gradually. The dose of inotropes and the volume load increased, and the CRRT was discontinued. Comparison of outcomes was made with a matched historic ECMO control group. The core body temperature, pulmonary arterial wedge pressure, mean arterial pressure, cardiac index, the doses of inotropes and vasopressors, mean arterial pressure and cardiac index were observed and recorded. The time for supportive treatment, successful off-line rate, ICU time and hospital stay, and the survival rate during the ICU and hospital stay were compared between two groups. Results Core body temperature was maintained at (34.0±0.5) ℃ during the combined therapy; Pulmonary arterial wedge pressure, the doses of inotropes and vasopressors, MAP and CI substantially decreased during the combined therapy (P0.05). There were no major complications in CRRT/MHT group. Conclusions These findings suggest that patients with acute severe heart failure after cardiovascular surgery can benefit from a strategy of CRRT/MHT. The results have given us new insight into the treatment of these patients.