• Bjoern Zante, Hermann Reichenspurner, Mathias Kubik, Joerg C Schefold, and Stefan Kluge.
• Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany; Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: bjoern.zante@insel.ch.
• Heart Lung. 2019 Sep 1; 48 (5): 421-427.

BackgroundInvasive procedures such as cardiac surgery are associated with perioperative dysfunction of macrocirculation and/or microcirculation and organ failures. Maintenance or resuscitation of an adequate macrocirculation and/or microcirculation is thus crucial in patients after cardiac surgery. We investigated the prognostic power of early central venous-arterial carbon dioxide pressure difference (delta-pCO2) after cardiac surgery.MethodsRetrospective analysis of data from 1,019 cardiac surgery patients treated in the ICU of a tertiary medical care academic center. Clinical outcomes and laboratory measures including metabolic indices and calculated delta-pCO2 were assessed. Receiver operating characteristic (ROC) curves were generated and sensitivity / specificity analysis was performed. Univariate and multivariate regression models were analyzed.ResultsThe area under the ROC curve for delta-pCO2 to predict ICU mortality was 0.72 (sensitivity 65% / specificity 76%) with an optimal delta-pCO2 cut-off value of 8.6 mmHg. In multivariate regression, delta-pCO2 was associated with increased ICU mortality (HR 3.72, 95%-CI 1.3-10.66, p = 0.02). After adjustment for typical confounders, delta-pCO2 remained as independent predictor of ICU mortality after cardiac surgery.ConclusionsIn a retrospective data analysis in a large sample of adult post cardiac surgery patients treated in the ICU, we observed that admission central venous-arterial delta-pCO2 independently predicts ICU mortality. Delta-pCO2 might thus contribute risk stratification in ICU patients after cardiac surgery.Copyright © 2019 Elsevier Inc. All rights reserved.

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