Prolonged Mechanical Ventilation After Aortic Arch Repair Requiring Deep Hypothermic Circulatory Arrest: Incidence, Effect on Outcome, and Clinical Predictors

Objective: To delineate the incidence, outcome impact, and clinical predictors of prolonged mechanical ventilation (PMV) after adult aortic arch repair requiring deep hypothermic circulatory arrest (AAR-DHCA) Aims: (1) To determine the incidence of PMV after AAR–DHCA. (2) To determine whether PMV after AAR-DHCA is a multivariate predictor for mortality or length of stay in the intensive care unit. (3) To determine multivariate predictors for PMV after AAR-DHCA. (4) To determine whether aprotinin influences PMV after AAR-DHCA. Study Design: Retrospective and observational. Prolonged mechanical ventilation was defined as mechanical ventilation via an endotracheal tube for longer than 72 hours. Study Setting: Single large university hospital. Participants: All adults undergoing AAR-DHCA in 2000 and 2001. Main Results: Cohort size was 144. Antifibrinolytic exposure was 100%: aprotinin 66% and aminocaproic acid 34%. The incidence of AF was 21.5 %. PMV did not independently predict for mortality or prolonged stay in the intensive care unit. The multivariate predictors for PMV were chronic obstructive pulmonary disease, stroke, and infection. In multivariate analysis, aprotinin exposure has no significant association with PMV. Conclusions: PMV after AAR-DHCA is common, but does not independently predict mortality or ICU stay. The risk of PMV after AAR-DHCA increases with preexisting chronic obstructive pulmonary disease, stroke and infection. Perioperative intervention should focus on protection against stroke and infection.