Wang Haoshi, Yang Heng, Liu Jia, Zhang Haonan, Feng Yaoguang, Lei Zhengwen
School of Nursing, University of South China, Hengyang, 421001, Hunan, China.
Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
Eur J Med Res. 2025 Aug 29;30(1):818. doi: 10.1186/s40001-025-03096-z.
Critical gaps persist in clinical guidelines and resuscitation strategies for induction and maintenance phase peri-anesthetic cardiac arrest (IM-PACA), urgently necessitating exploration of feasible solutions during anesthesia induction and maintenance periods. This study evaluates a modified cardiopulmonary bypass (CPB) strategy for managing IM-PACA in valvular heart disease (VHD) surgical patients.
A retrospective analysis was performed on IM-PACA patients (n = 21) from 1,043 cardiac valve surgeries between March 2019 and January 2022 as the cardiac arrest-resuscitation group (CAR group). Patients who completed normal cardiac valve surgery (n = 84) were randomly selected from the medical record database as the Routine Surgery group (RS group), serving as a benchmark control for the standard efficacy of routine surgery. The CAR group completed surgery after modified cardiopulmonary bypass strategy; the RS group completed surgery as planned. This study reviewed the possible causes of cardiac arrest in the CAR group and performed statistical analysis on surgical time-related metrics (total surgical duration, cardiopulmonary bypass duration, etc.) and postoperative follow-up data (paravalvular leak, cardiac-related complications, etc.) using SPSS 26.0.
The short-term postoperative survival rate was 95.24% in the CAR group and 100% in the RS group. Baseline characteristics including gender, age, and smoking history showed no significant differences between the two groups (P > 0.05). The CAR group showed a significantly shorter pericardiotomy-to-CPB time (250.00 (205.00-269.50) vs. 512.50 (459.25-563.00) s; P < 0.001), but longer rewarming time (68.00 (63.50-74.50) vs. 48.00 (35.25-61.75) min; P < 0.001), ventilator duration (980.00 (619.00-1106.50) vs. 900.00 (630.00-1103.75) min; P = 0.002), and higher day 2 drainage (190 (157.50-215.00) vs. 105 (71.25-150.00) ml; P < 0.001) compared to the RS group. Other intraoperative and postoperative parameters revealed no statistically significant differences when compared with the RS group (P > 0.05).
For IM-PACA patients undergoing cardiac valve surgery, the modified cardiopulmonary bypass strategy is an effective rescue method, and the strategy of continuing surgery after resuscitation is completely feasible.
围麻醉期心脏骤停诱导和维持阶段（IM-PACA）的临床指南和复苏策略仍存在重大差距，迫切需要探索麻醉诱导和维持期间的可行解决方案。本研究评估了一种改良体外循环（CPB）策略，用于管理瓣膜性心脏病（VHD）手术患者的IM-PACA。
对2019年3月至2022年1月期间1043例心脏瓣膜手术中的IM-PACA患者（n = 21）进行回顾性分析，作为心脏骤停复苏组（CAR组）。从病历数据库中随机选择完成正常心脏瓣膜手术的患者（n = 84）作为常规手术组（RS组），作为常规手术标准疗效的基准对照。CAR组采用改良体外循环策略完成手术；RS组按计划完成手术。本研究回顾了CAR组心脏骤停的可能原因，并使用SPSS 26.0对手术时间相关指标（总手术时长、体外循环时长等）和术后随访数据（瓣周漏、心脏相关并发症等）进行统计分析。
CAR组术后短期生存率为95.24%，RS组为100%。两组间性别、年龄和吸烟史等基线特征无显著差异（P > 0.05）。与RS组相比，CAR组心包切开至体外循环时间显著缩短（250.00（205.00 - 269.50）秒 vs. 512.50（459.25 - 563.00）秒；P < 0.001），但复温时间更长（68.00（63.50 - 74.50）分钟 vs. 48.00（35.25 - 61.75）分钟；P < 0.001）、机械通气时长更长（980.00（619.00 - 1106.50）分钟 vs. 900.00（630.00 - 1103.75）分钟；P = 0.002），术后第2天引流量更高（190（157.50 - 215.00）毫升 vs. 105（71.25 - 150.00）毫升；P < 0.001）。与RS组相比，其他术中和术后参数无统计学显著差异（P > 0.05）。
对于接受心脏瓣膜手术的IM-PACA患者，改良体外循环策略是一种有效的抢救方法，复苏后继续手术的策略完全可行。
