Medical Department, SpecialtyCare, Brentwood, TN, USA.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
Perfusion. 2022 May;37(4):350-358. doi: 10.1177/02676591211018983. Epub 2021 May 27.
The outbreak of the novel coronavirus pandemic (COVID-19) has resulted in dramatic changes to the conduct of surgery both from a patient management perspective and in protecting healthcare providers. The current study reports on the status of COVID-19 infections in patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) on circuit complications. A tracking process for monitoring the presence of COVID-19 in adult cardiac surgery patients was integrated into a case documentation system across United States hospitals where out-sourced perfusion services were provided. Assessment included infection status, testing technique employed, surgery status and CPB complications. Records from 5612 adult patients who underwent cardiac surgery between November 1, 2020 and January 18, 2021 from 176 hospitals were reviewed. A sub-cohort of coronary artery bypass graft patients (3283) was compared using a mixed effect binary logistic regression analysis. 4297 patients had negative test results (76.6%) while 49 (0.9%) tested positive for COVID-19, and unknown or no results were reported in 693 (12.4%) and 573 (10.2%) respectively. Coagulation complications were reported at 0.2% in the negative test results group versus 4.1% in the positive test result group (p < 0.001). Oxygenator gas exchange complications were 0.2% in the negative test results group versus 2.0% in the positive test results group (p = 0.088). Coronary artery bypass graft patients with a positive test had significantly higher risk for any CPB complication (p = 0.003) [OR 10.38, CI 2.18-49.53] then negative test patients [OR 0.01, CI 0.00-0.20]. The present study has shown that patients undergoing cardiac surgery with CPB who test positive for COVID-19 have higher CPB complication rate than those who test negative.
新型冠状病毒大流行（COVID-19）的爆发导致手术的进行方式发生了巨大变化，无论是从患者管理的角度还是从保护医疗保健提供者的角度来看都是如此。本研究报告了在使用体外循环（CPB）回路并发症接受心脏手术的患者中，COVID-19 感染的状况。在美国的医院中，一种监测成人心脏手术患者中 COVID-19 存在的跟踪过程被整合到病例文档系统中，这些医院提供外包的灌注服务。评估包括感染状况、所采用的检测技术、手术状态和 CPB 并发症。对 2020 年 11 月 1 日至 2021 年 1 月 18 日期间来自 176 家医院的 5612 例成年患者的记录进行了回顾。使用混合效应二项逻辑回归分析对冠状动脉旁路移植术患者（3283 例）的亚组进行了比较。4297 例患者的检测结果为阴性（76.6%），49 例（0.9%）COVID-19 检测结果为阳性，693 例（12.4%）和 573 例（10.2%）分别报告了未知或无结果。在阴性检测结果组中，凝血并发症的发生率为 0.2%，而在阳性检测结果组中为 4.1%（p<0.001）。在阴性检测结果组中，氧气交换器气体交换并发症的发生率为 0.2%，而在阳性检测结果组中为 2.0%（p=0.088）。COVID-19 检测阳性的冠状动脉旁路移植术患者的任何 CPB 并发症风险显著更高（p=0.003）[比值比 10.38，95%置信区间 2.18-49.53]，而 COVID-19 检测阴性的患者[比值比 0.01，95%置信区间 0.00-0.20]。本研究表明，COVID-19 检测阳性接受 CPB 心脏手术的患者 CPB 并发症发生率高于 COVID-19 检测阴性的患者。
