• Matthias Jacquet-Lagrèze, Faustine Bredèche, Claire Louyot, Matteo Pozzi, Daniel Grinberg, Michele Flagiello, Philippe Portran, Martin Ruste, Rémi Schweizer, and Jean-Luc Fellahi.
• Département d'anesthésie-réanimation, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France; CarMeN Laboratory, Inserm UMR 1060, University Claude Bernard Lyon 1, Lyon, Fransce. Electronic address: jacquet-lagreze@chu-lyon.fr.
• J. Cardiothorac. Vasc. Anesth. 2023 Sep 1; 37 (9): 163116381631-1638.

ObjectiveThe aortic-to-radial arterial pressure gradient is described during and after cardiopulmonary bypass (CPB), and can lead to underestimating arterial blood pressure. The authors hypothesized that central arterial pressure monitoring would be associated with lower norepinephrine requirements than radial arterial pressure monitoring during cardiac surgery.DesignAn observational prospective cohort with propensity score analysis.SettingAt a tertiary academic hospital's operating room and intensive care unit (ICU).ParticipantsA total of 286 consecutive adult patients undergoing cardiac surgery with CPB (central group: 109; radial group: 177) were enrolled and analyzed.InterventionsTo explore the hemodynamic effect of the measurement site, the authors divided the cohort into 2 groups according to a femoral/axillary (central group) or radial (radial group) site of arterial pressure monitoring.Measurement And Main ResultsThe primary outcome was the intraoperative amount of norepinephrine administered. Secondary outcomes included norepinephrine-free hours and ICU-free hours at postoperative day 2 (POD2). A logistic model with propensity score analysis was built to predict central arterial pressure monitoring use. The authors compared demographic, hemodynamic, and outcomes data before and after adjustment. Central group patients had a higher European System for Cardiac Operative Risk Evaluation. (EuroSCORE) compared to the radial group-7.9 ± 14.0 versus 3.8 ± 7.0, p < 0.001. After adjustment, both groups had similar patient EuroSCORE and arterial blood pressure levels. Intraoperative norepinephrine dose regimens were 0.10 ± 0.10 µg/kg/min in the central group and 0.11 ± 0.11 µg/kg/min in the radial group (p = 0.519). Norepinephrine-free hours at POD2 were 38 ± 17 hours versus 33 ± 19 hours in central and radial groups, respectively (p = 0.034). The ICU-free hours at POD2 were greater in the central group: 18 ± 13 hours versus 13 ± 13 hours, p = 0.008. Adverse events were less frequent in the central group than in the radial group-67% versus 50%, p = 0.007.ConclusionsNo differences in the norepinephrine dose regimen were found according to the arterial measurement site during cardiac surgery. However, norepinephrine use and length of stay in the ICU were shorter, and adverse events were decreased when central arterial pressure monitoring was used.Copyright © 2023 Elsevier Inc. All rights reserved.

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