Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-Directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial.

Purpose: Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study's objective was to evaluate the FloTrac/EV1000 platform's efficacy for improving postoperative outcomes in cardiac surgery.

Patients And Methods: Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥0.5 mL·kg·h; oxygen saturation >95%; and hematocrit 26-30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33-65 mL·beat·m; cardiac index 2.2-4.0 L·min·m; and systemic vascular resistance index 1600-2500 dynes·s·cm·m.

Results: The intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference -29.5 h; 95% CI -17.2 to -41.8, < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference -11.3 h; 95% CI -2.7 to -19.9, = 0.011). The hospital LOS was shorter in the EGDT group (mean difference -1.1 d; 95% CI -0.1 to -2.1, = 0.038).

Conclusion: EGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.