Hyperoxia during cardiopulmonary bypass does not decrease cardiovascular complications following cardiac surgery: the CARDIOX randomized clinical trial

• Published in: Intensive care medicine 2019-10, Vol.45 (10), p.1413-1421
• Main Authors: Abou-Arab, Osama, Huette, Pierre, Martineau, Lucie, Beauvalot, Clémence, Beyls, Christophe, Josse, Estelle, Touati, Gilles, Bouchot, Olivier, Bouhemad, Belaïd, Diouf, Momar, Lorne, Emmanuel, Guinot, Pierre-Grégoire
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiology; Atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - etiology; Biological Physics; Blood pressure; Cardiac arrhythmia; Cardiac Surgical Procedures - methods; Cardiopulmonary Bypass - methods; Cardiopulmonary Bypass - standards; Cardiopulmonary Bypass - statistics & numerical data; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - surgery; Cerebral blood flow; Clinical trials; Complications; Complications and side effects; Coronary artery bypass; Critical Care Medicine; Emergency Medicine; ESICM Lives Clinical Trials; Evidence-based medicine; Female; Fibrillation; France; France - epidemiology; Heart; Heart surgery; Hospitals; Humans; Hyperoxia; Hyperoxia - complications; Hyperoxia - physiopathology; Incidence; Intensive; Intensive care; Intervention; Ischemia; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Original; Oxygen; Oxygen - blood; Oxygen - therapeutic use; Pain Medicine; Patients; Pediatrics; Physics; Pneumology/Respiratory System; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Period; Reduction; Reperfusion; Risk management; Surgery; Tachycardia; Ventricle; Ventricular fibrillation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-019-05761-4

Purpose Data on the benefit or or harmful effects of oxygen level on ischemic reperfusion injuries in cardiac surgery are insufficient. We hypothesized that hyperoxia during cardiopulmonary bypass decreases the incidence of postoperative atrial fibrillation (POAF) and ventricular fibrillation, and therefore decreases cardiovascular morbidity (CARDIOX study). Methods An open-label, randomized clinical trial including adults undergoing elective cardiac surgery, i.e. cardiopulmonary bypass (CPB) randomized 1:1 to an intervention group or standard group at two French University Hospitals from June 2016 to October 2018. The intervention consisted in delivering of an inspired fraction of oxygen of one to one during CPB. The standard care consisted in delivering oxygen to achieve a partial arterial blood pressure less than 150 mmHg. The primary endpoint was the occurrence of POAF and/or ventricular tachycardia/ventricular fibrillation (VT/VF) within the 15 days following cardiac surgery. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACCE: in-hospital mortality, stroke, cardiac arrest, acute kidney injury, and mesenteric ischemia). Results 330 patients were randomly assigned to either the intervention group ( n  = 161) or the standard group ( n  = 163). Mean PaO 2 was 447 ± 98 mmHg and 161 ± 60 mmHg during CPB, for the intervention and standard group ( p