ABSTRACT PRESENTATIONS
four patients (35%) developed vasoplegia. In the multivariable
logistic regression analysis, the pre-operative use of aldosterone
antagonists (OR 1.76, 95%CI 1.02-3.04) and the EuroscoreII (OR
1.06, 95%CI 1.03-1.08) were significantly related to vasoplegia.
The discriminative ability of the UVPS to predict vasoplegia was
reasonable (AUC ¼ 0.74, 95%CI 0.66-0.82, po0.001).
Discussion. Vasoplegia affects almost one-third of our primary
cfLVAD patients. The ability to predict patients at risk using the
VPS is promising. It might help to better time cfLVAD implanta-
tion in an attempt to prevent vasoplegia and associated multi-
system organ dysfunction.
OP-55
Implication of Vasopressin in the vascular response to
myocardial infarction and cardiogenic shock in a rat model
Philippe Gaudard1,2, H. David1,2, C. Farah2, P. Bideaux2,
S. Richard2, A. Virsolvy2, P. Colson1
1
CHU Montpellier, France, 2INSERM U1046 Montpellier, France
Introduction. Acute heart failure (AHF) due to acute myocardial
infarction (AMI) is likely to involve cardiogenic shock (CS) when
early revascularization is not efficient. CS is a state of end-organ
hypoperfusion consecutive to cardiac failure with neuro-
hormonal activation. The increase of vasopressin (AVP) release
has been associated with adverse outcome in AHF (1). AVP may
be responsible for microcirculation alterations with inadequate
tissue oxygenation (2) leading to multiple organs failure and
death. The aim of the experimental study was to investigate the
implication of AVP, studied by in vitro vascular reactivity, in the
alterations of circulation observed in AMI and CS.
Methods. Wistar rats were assigned to two groups: Sham (16
animals), operated without coronary ligation, and post-
myocardial infarction (PMI; 17 animals) induced by left coronary
artery ligation and followed-up by changes of myocardial
coloration and electrocardiogram. One day after surgery (D1),
echocardiography was performed to validate AMI and left
ventricular failure by comparison with preoperative examination.
Ex-vivo arterial contractile responses to AVP were evaluated on
conductance (aorta) and resistance (renal) arteries. Results were
compared between Sham and PMI.
Results. Ejection fraction (EF) and cardiac output were similar in
Sham and PMI groups at D0 (64 vs. 64% and 161 vs. 180 ml.
min-1, NS) but were decreased in PMI group at D1 (respectively
61 vs. 44%, po0.01 and 162 vs. 116 ml/min-1, po0.01). In PMI
group, postoperative echocardiography was performed in good
conditions in 12 rats. We found an EF440% in 7 rats and an
EFo40% in 5 rats. In renal artery contractile response to AVP
was decreased in PMI when compared to Sham (0.11 vs. 0.29g,
po0.01). On aorta, maximal contraction and affinity to AVP
receptors were decreased only for EFo40%. This decreased
contractile response to AVP was linearly correlated to a low EF
(p¼0.046; r2¼0.91).
Discussion. Alterations in the contractile responses of arteries to
AVP occurs very early after MI. The renal artery was more impacted,
whilst in conductance artery reactivity to AVP varied as a function of
EF. The decrease of the sensitivity to AVP may result from an over-
stimulation of this system. The question of whether the reduced
S43
vascular response to AVP may alter the microcirculation and impact
AMI outcome warrants further studies.
REFERENCES
1. Voors A, et al: Eur Heart J 30:1187-94, 2009.
2. Friesenecker B, et al: Am J Physiol Heart Circ Physiol 287:
H1792-H1800, 2004.
Poster Session PS06
Friday, May 13, 2016
11:00 - 13:00, Poster Exhibition Lounge
P-35
In-simulo evaluation of a prototype device to reduce medi-
cation errors in anaesthesia: A proof-of-concept study
Shariq Ali Khan, H. Kothandan
Singapore General Hospital, Department of Anaesthesiology,
Singapore
Introduction. Substitution errors (defined as, drawing a drug from
the wrong ampoule (¼ampoule-swap) or/and administration of
wrong drug-filled syringe (¼syringe-swap)) are responsible for up
to 60% of medication errors in Anaesthesia.While existing anaes-
thesia medication safety devices (like Codonics Label-printer and
SaferSleep system) address the problem of ampoule-swaps;
syringe-swap remains a problem, because these systems have
been found to be unsuccessful in prompting the user to scan the
drug-filled syringe prior to IV administration (25 to 62%).2,3 We
hypothesize that by creating a physical barrier, user behavior can be
modified into following a safer method of intravenous (IV) drug
administration. To test our hypothesis we developed a device which
attaches to the drug administration port of the patients IV tubing, and
allows injection of IV drug only after the user scans the drug-label.
We tested the effect of the device on drug administration behavior of
Anaesthesia specialists in a high fidelity Simulation environment. The
primary outcome measured was compliance with safe drug admin-
istration procedure (defined as scanning drug-ampoule to print a
label for the syringe and scanning of labelled-syringe before
administering it intravenously). Secondarily we measured, syringe
labeling compliance with ASA labelling standards.
Methods. After obtaining informed consent, 10 participating Anaes-
thesiologist, who were unaware of the primary outcome being
measured, were asked to administer a general anaesthetic for 2
simulated cases each in the simulation OT (control case and
intervention case, in random order). The control case used the
Codonics label-printer but did not have our device, while the
intervention case had the Codonics label-printer and our prototype
device. An observer recorded the primary outcome without knowl-
edge of the anaesthesiologist. Chi-square test was used for
intergroup comparison and statistical significance was defined as
p value o0.05.
Results. A total of 182 intravenous drug administration occurred
in the study (91 in each in Control and Intervention group).
Primary Outcome occurred in 33 (36.3%) drug administrations in
the control group compared to all 91(100%) in the intervention
group (po0.05). All the syringe labels in the both the groups
were found to be compliant to ASA labelling standards.