Intraoperative hemodynamic management in abdominal aortic surgery guided by the Hypotension Prediction Index: the Hemas multicentric observational study.

Abstract

Background: Intraoperative hypotension (IOH) during non-cardiac surgery is closely associated with postoperative complications. Hypotensive events are more likely during major open vascular surgery. We prospectively investigated whether our institutional algorithm of cardiocirculatory management, which included the Hypotension Prediction Index (HPI), a predictive model of hypotension of the Hemosphere™ platform (Edwards Lifescience, Irwin, CA, USA), was able to reduce the incidence and severity of intraoperative hypotension during open abdominal aortic aneurysm repair.

Methods: A multi-center observational study was conducted at IRCCS-Humanitas Research Hospital (Milan) and AO Mauriziano Umberto I Hospital (Turin) between July 2022 and September 2023, enrolling patients undergoing elective open abdominal aortic aneurysm repair. A hemodynamic protocol based on the Acumen-HPI Hemosphere™ platform was employed, integrating advanced parameters (e.g., HPI, Ea-dyn, dP/dt) and tailored interventions to minimize intraoperative hypotension. The primary endpoint was cumulative intraoperative hypotension time < 10% of surgical time, with secondary endpoints including incidence of hypotensive events, time-weighted averages of MAP < 65 mmHg (TWA65) and < 50 mmHg (TWA50), and postoperative complications.

Results: We enrolled 53 patients submitted to open abdominal aortic repair. The primary endpoint (time in hypotension < 10%) was successfully reached: 5 [1-10] %. The targeted time-weighted average (< 0.40 mmHg) both for MAP < 65 mmHg (TWA65) and MAP < 50 mmHg (severe hypotension; TWA50) were reached: TWA65 = 0.26 [0.04-0.65] mmHg and TWA50 = 0.00 [0.00-0.01].

Conclusions: Our hemodynamic management algorithm based on the HPI and other parameters of the Hemosphere™ platform was able to limit the incidence and severity of intraoperative hypotension during open abdominal aortic repair.

Trial registration: NCT05478564.