Presentation and Outcomes of Patients With Preoperative Critical Illness Undergoing Cardiac Surgery

• Published in: JACC. Advances (Online) 2023-03, Vol.2 (2), p.100260, Article 100260
• Main Authors: Metkus, Thomas S., Alviar, Carlos L., Baird-Zars, Vivian M., Barsness, Gregory W., Berg, David D., Bohula, Erin A., Burke, James A., Fordyce, Christopher B., Guo, Jianping, Katz, Jason N., Keeley, Ellen C., Menon, Venu, Miller, P. Elliott, O'Brien, Connor G., Sinha, Shashank S., So, Derek, Ternus, Bradley W., Vadhar, Sagar, van Diepen, Sean, Morrow, David A.
• Format: Article
• Language: English
• Subjects: CABG; cardiac intensive care unit; cardiac surgery; ICU
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2023.100260

Little is known about the prevalence and post-surgical outcomes associated with cardiac intensive care unit (CICU) therapeutics among CICU patients referred for cardiac surgery. The purpose of this study was to investigate the clinical characteristics and outcomes of CICU patients referred for cardiac surgery from the intensive care unit. We analyzed characteristics and outcomes of CICU admissions referred from the CICU for cardiac surgery during 2017 to 2020 across 29 centers. The primary outcome was in-hospital mortality. Among 10,321 CICU admissions, 887 (8.6%) underwent cardiac surgery, including 406 (46%) coronary artery bypass graftings, 201 (23%) transplants or ventricular assist devices, 171 (19%) valve surgeries, and 109 (12%) other procedures. Common indications for CICU admission included shock (33.5%) and respiratory insufficiency (24.9%). Preoperative CICU therapies included vasoactive therapy in 52.2%, mechanical circulatory support in 35.9%, renal replacement in 8.2%, mechanical ventilation in 35.7%, and 17.5% with high-flow nasal cannula or noninvasive positive pressure ventilation. In-hospital mortality was 11.7% among all CICU admissions and 9.1% among patients treated with cardiac surgery. After multivariable adjustment, pre-op mechanical circulatory support and renal replacement therapy were associated with mortality, while respiratory support and vasoactive therapy were not. Nearly 1 in 12 contemporary CICU patients receive cardiac surgery. Despite high preoperative disease severity, CICU admissions undergoing cardiac surgery had a comparable mortality rate to CICU patients overall; highlighting the ability of clinicians to select higher acuity patients with a reasonable perioperative risk. [Display omitted]