Care guided by tissue oxygenation and haemodynamic monitoring in off-pump coronary artery bypass grafting (Bottomline-CS): assessor blind, single centre, randomised controlled trial.

Summary

In 1960 older adults undergoing off-pump CABG, guided care using multisite NIRS and haemodynamic monitoring kept tissue oxygenation near baseline but did not reduce the 30-day composite of major complications (47.3% vs 47.8%; RR 0.99, P=0.83). No secondary outcomes differed significantly after multiplicity adjustment; pneumonia was numerically lower with guided care.

Key Findings

• Guided care significantly reduced time outside ±10% of baseline tissue oxygenation across forehead and forearm sites.
• No reduction in 30-day composite complications (47.3% vs 47.8%; RR 0.99, 95% CI 0.90–1.08; P=0.83).
• Secondary outcomes, including mortality and atrial fibrillation, showed no significant differences; pneumonia was numerically lower with guided care.

Clinical Implications

Routine use of NIRS-guided tissue oxygenation targeting during off-pump CABG is not supported to reduce complications; resources may be better allocated to interventions with proven benefit.

Limitations

• Single-centre trial limits generalizability
• Restricted to off-pump CABG and patients aged ≥60 years

Future Directions

Multicentre trials to test targeted NIRS strategies in high-risk subgroups and cost-effectiveness analyses; exploration of combined neuromonitoring approaches.