The association between rhabdomyolysis and acute renal failure in patients undergoing cardiopulmonary bypass
Maccario, M.; Fumagalli, C.; Dottori, V.; Grasso, A.M.; Agostini, M.; Parodi, E.; Pergolo, A.; Spagnolo, S.; Passerone, G.
Journal of Cardiovascular Surgery 37(2): 153-159
1996
ISSN/ISBN: 0021-9509 PMID: 8675522 Document Number: 457886
Objective: The authors describe 9 cases of rhabdomyolytic acute renal failure (ARF) as a complication of cardiopulmonary bypass. Experimental design: Retrospective research, between June 1992 and March 1994. Setting: Department of Cardiac Surgery. Patients: 931 consecutive patients undergoing major cardiac surgery. Interventions: Patients affected by rhabdomyolytic ARF were treated with pharmacological therapy and/or plasmapheresis/continuous arteriovenous hemofiltration. In seven patients indirect cannulation of the femoral artery was used. Measures: Incidence, risk factors of syndrome and results obtained with pharmacological treatment, CAVH and plasmapheresis were evaluated. Statistical analysis was performed with ANOVA, Tukey Kramer test and XI test (p lt 0.05 as significant). Results: The syndrome occurred in 0.96% (9/931 patients) of the total cases; 11.3% (6/53 -p lt 0.0000) in patients undergoing a direct femoral artery cannulation for cardiopulmonary bypass and 9.5% (2/21, p lt 0.01) in patients in which the aortic balloon pump was used. Six patients develop acute anuric renal failure and underwent plasma exchange and hemodialysis (1 case) or CAVH (5 cases); 3 patients underwent early medical treatment and developed acute renal failure (ARF) with preserved diuresis. Early medical therapy appeared to prevent the evolution towards anuric ARF. The indirect cannulation of the femoral artery does not seem to produce a rhabdomyolytic ARF syndrome. In patients with direct femoral artery cannulation risk factors appears to be: arteriopathy (p lt 0.001), prolonged extra corporeal circulation (p lt 0.001), low cardiac output syndrome (p lt 0.001), continuous i.v. infusion of epinephrine (p lt 0.0001). Conclusions: Rhabdomyolytic acute renal failure is a severe complication, early identification of patients "at risk" is most important. The preventive measures and the therapy adopted proved efficient.