Key result
Cardiac surgery in CICU admissions is associated with in-hospital mortality comparable to non-surgical patients.
Why the study?
Little is known regarding the prevalence and post-surgical outcomes associated with CICU therapeutics among CICU patients referred for cardiac surgery.
What are the clinical characteristics and in-hospital mortality outcomes of CICU patients referred for cardiac surgery?
Observational (n=10,321)
Yes
What are the clinical characteristics and in-hospital mortality outcomes of CICU patients referred for cardiac surgery?
Absolute Event Rate: 9.1% vs 11.9%
Despite high preoperative disease severity, CICU patients undergoing cardiac surgery have a comparable in-hospital mortality rate to the overall CICU population, suggesting appropriate patient selection by clinicians.
Supports surgical referral for selected CICU patients; leaves open whether preoperative MCS or RRT should modify thresholds prospectively.
BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Metkus et al. (2023) conducted an observational in Cardiac critical illness (n=10,321). Cardiac surgery vs. No cardiac surgery was evaluated on In-hospital mortality. Cardiac surgery was performed in 8.6% of cardiac intensive care unit admissions and was associated with a 9.1% in-hospital mortality rate, comparable to the 11.9% mortality of non-surgical patients.
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