Seek and You Shall Find – but Then What Do You Do? Cold Agglutinins in Cardiopulmonary Bypass, and a Single Center Experience with Cold Agglutinin Screening Before Cardiac Surgery
Notice bibliographique
Résumé
Abstract Abstract 4372 Background: Cardiopulmonary bypass (CPB) during cardiac surgery typically involves deliberate hypothermia of the systemic (22 – 36°C) and coronary circulations (down to 8 – 12°C). Adverse sequelae of previously undiagnosed cold-active antibodies have been feared and reported under such conditions. For this reason, some centers elect to screen for cold agglutinins prior to CPB. Some groups also intervene when a positive screen is noted, by electing to modify CPB conditions to lessen hypothermia in such patients. Aim: To determine the yields and effects of cold agglutinin screening (CAS) in pre-operative cardiac surgery patients planned for CPB. Methods: Literature review and retrospective cohort study of 14,900 patients undergoing CPB and cardiac surgery over 8 years at our institution. Results: The majority of the literature consists of case reports and case series. The literature review found that patients with a positive CAS had infrequent adverse events when undergoing CPB. These included 4 cases where complications were likely attributable to cold agglutinins, 4 cases where complications were possibly due to cold agglutinins and 158 cases where no complications were noted, despite a likely bias towards case reporting adverse events. Analysis of a retrospective cohort of 14,900 patients undergoing CPB and cardiac surgery at our institution identified 47 patients (0.3%) with positive cold agglutinin screens (CAS+) over 8 years. The annual testing cost was $17,000 CAD. Compared to the cohort of CAS-negative patients, CAS+ patients had a statistically longer ICU length of stay [median 54.6 hours (IQR 24 – 166) vs. 42.8 hours (IQR 23 – 70), P = 0.021] and hospital length of stay [median 7 days (IQR 6 – 14) vs. 7 days (IQR 5 – 9), P = 0.044]. However, the composite of mortality or severe morbidity (stroke, MI, dialysis, low output, sepsis, and DVT) was not significantly different in comparing the CAS+ and CAS-negative groups (14.9% vs. 9.2%, P = 0.2). The response of the surgical team to the pre-operative discovery of a CAS+ patient was variable, with CPB modified to avoid hypothermia in approximately one-third of cases. Modification of CPB to avoid hypothermia in the CAS+ group did not lead to better outcomes. Patients undergoing unmodified (standard) CPB had an event rate of 10.3% on the composite outcome, while patients undergoing modified (less hypothermic) CPB had an event rate of 20.0% (P = 0.647). Antibody verification found that only 43% of positive CAS patients had true cold agglutinins (20 patients). Half of these patients had unmodified CPB, while the other half had modified CPB. Event rates were low, with 1 out of 10 patients reaching the composite outcome in each group. Conclusion: Based upon historical and local data, we conclude that preclinical CAS is cost-substantial, does not effectively identify true-positive patients, and does not lead to an intervention that meaningfully improves patient outcomes during surgery. We do not recommend CAS in asymptomatic cardiac surgery patients. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».