Reduced incidence of atrial fibrillation after cardiac surgery by continuous wireless monitoring of oxygen saturation on the normal ward and resultant oxygen therapy for hypoxia

• Published in: European journal of cardio-thoracic surgery Vol. 35; no. 1; pp. 111 - 115
• Main Authors: Kisner, Dilek, Wilhelm, Markus J., Messerli, Michael S., Zünd, Gregor, Genoni, Michele
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Science B.V 01-01-2009; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Atrial fibrillation; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Auricall; Biological and medical sciences; Cardiac dysrhythmias; Cardiac surgery; Cardiac Surgical Procedures - adverse effects; Cardiology. Vascular system; Coronary Artery Bypass; Female; Heart; Humans; Hypoxia - diagnosis; Hypoxia - etiology; Hypoxia - therapy; Male; Medical sciences; Middle Aged; Monitoring, Physiologic - methods; Oxygen - blood; Oxygen Inhalation Therapy; Oxygen therapy; Pneumology; Postoperative Care - methods; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Telemetry - methods; Wireless monitoring; Wireless monitoring; Cardiac surgery; Oxygen therapy; Auricall; Atrial fibrillation; Oxygen; Arrhythmia; Saturation; Cardiovascular disease; Normal; Excitability disorder; Incidence; Continuous process; Treatment; Surveillance; Heart disease; Hypoxia; Circulatory system; Cardiology; Monitoring; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.08.015

Objective: Monitoring of cardiac surgical patients after transfer from the intensive care unit to the normal ward is incomplete. Undetected hypoxia, however, is known to be a risk factor for occurrence of atrial fibrillation. We have utilized Auricall® for continuous wireless monitoring of oxygen saturation and heart rate until discharge. The object of the study was to analyze if oxygen therapy as a result of Auricall® alerts of hypoxia can decrease the incidence of postoperative atrial fibrillation. Methods: Auricall® is a wireless portable pulse oximeter. An alert is generated depending on preset threshold values (heart rate, oxygen saturation). Over a period of 6 months, 119 patients were monitored with the Auricall® following coronary artery bypass graft and/or valve surgery. Oxygen therapy was started subsequent to an oxygen saturation below 90%. These patients were compared with a cohort of 238 patients from the time period before availability of Auricall®. The patient characteristics were comparable in both groups. In a retrospective study, the incidence of atrial fibrillation was measured in both groups. Results: The postoperative AF was observed in 22/119 patients (18%) in group I and in 66/238 patients (28%) in group II. This difference between the two groups approached significance (p = 0.056). In the subgroup of patients with coronary artery bypass graft with our without simultaneous valve surgery (n = 312), Auricall® monitoring resulted in a significantly reduced incidence of atrial fibrillation (14% vs 26%, p = 0.016). Conclusions: Continuous monitoring of oxygen saturation on the normal ward and subsequent oxygen therapy for hypoxia can reduce the incidence of atrial fibrillation in a subgroup of patients after cardiac surgery. Prospective randomized trials are warranted to confirm these data.