Original ArticleNonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process
Section snippets
Methods
Cardiac anesthesiologists, cardiac surgeons, intensivists, and cardiologists participated in this updated consensus conference in cardiac surgery mortality. They participated in person, through e-mail, or through the congress website (Fig 1).
Medline/PubMed, Scopus, and Embase were searched by 4 investigators (GL, SS, EF, MBR, CS) with no publication time limits, and the results were updated on November 27, 2015, to identify all randomized controlled trials (RCTs) and non-RCTs of any nonsurgical
Results
The consensus process flowchart is shown in Figure 1. The web survey identified the following 10 interventions that decreased unadjusted landmark mortality: aspirin,18, 19 high-volume surgeon,20, 21, 22 glycemic control,23, 24, 25, 26 prophylactic intra-aortic balloon pump (IABP),27, 28, 29, 30, 31, 32 leuko-depleted red blood cell transfusion (RBC),33, 34 levosimendan,35, 36, 37, 38, 39, 40, 41 noninvasive ventilation (NIV),42, 43 tranexamic acid,44 vacuum-assisted closure (VAC),45 volatile
Key Findings
All nonsurgical interventions, including drugs, techniques, and strategies, which have been shown in at least 1 study published in a peer-reviewed journal to significantly affect mortality in patients undergoing cardiac surgery, were identified. In particular, the authors found that aspirin, glycemic control, high-volume surgery, prophylactic IABP, levosimendan, leuko-depleted RBC transfusion, NIV, tranexamic acid, VAC, and volatile agents might reduce mortality, whereas aprotinin likely
Conclusions
This updated, international, web-based consensus conference process identified 11 interventions supported by widely agreed-on evidence suggesting an effect on mortality among patients undergoing cardiac surgery. The analysis of web voting confirmed that there was a gap between evidence and clinical practice and that both the perception of literature evidence and the clinical attitude of cardiac anesthesiologists and intensivists were significantly different among different countries for many of
References (58)
- et al.
In-hospital outcomes and complications of coronary artery bypass grafting in the United States between 2008 and 2012
J Cardiothorac Vasc Anesth
(2017) - et al.
Surgical aortic valve replacement - clinical update on recent advances in the contemporary era
J Cardiothorac Vasc Anesth
(2016) - et al.
Democracy-based consensus in medicine
J Cardiothorac Vasc Anesth
(2015) - et al.
Randomized evidence for reduction of perioperative mortality
J Cardiothorac Vasc Anesth
(2012) - et al.
Randomized evidence for reduction of perioperative mortality: An updated consensus process
J Cardiothorac Vasc Anesth
(2017) - et al.
Reducing mortality in acute kidney injury patients: Systematic review and international web-based survey
J Cardiothorac Vasc Anesth
(2013) - et al.
Worldwide opinion on multicenter randomized interventions showing mortality reduction in critically ill patients: A democracy-based medicine approach
J Cardiothorac Vasc Anesth
(2016) - et al.
Impact of the anesthesiologist and surgeon on cardiac surgical outcomes
J Cardiothorac Vasc Anesth
(2014) - et al.
Procedure-specific cardiac surgeon volume associated with patient outcome following valve surgery, but not isolated CABG surgery
Heart Lung Circ
(2015) - et al.
Effects of intensive glycemic control on outcomes of cardiac surgery
Heart Lung
(2013)
A Bayesian network meta-analysis on the effect of inodilatory agents on mortality
Br J Anaesth
The calcium sensitizer levosimendan gives superior results to dobutamine in postoperative low cardiac output syndrome
Rev Esp Cardiol (Engl Ed)
Effect of levosimendan on survival and adverse events after cardiac surgery: A meta-analysis
J Cardiothorac Vasc Anesth
Reducing mortality in cardiac surgery with levosimendan: A meta-analysis of randomized controlled trials
J Cardiothorac Vasc Anesth
Levosimendan for prevention of acute kidney injury after cardiac surgery: A meta-analysis of randomized controlled trials
Am J Kidney Dis
Effects of non-invasive ventilation on reintubation rate: A systematic review and meta-analysis of randomised studies of patients undergoing cardiothoracic surgery
Crit Care Resusc
Desflurane and sevoflurane in cardiac surgery: A meta-analysis of randomized clinical trials
J Cardiothorac Vasc Anesth
The effect of isoflurane on survival and myocardial infarction: A meta-analysis of randomized controlled studies
J Cardiothorac Vasc Anesth
Anaesthetic drugs and survival: A Bayesian network meta-analysis of randomized trials in cardiac surgery
Br J Anaesth
A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design
Am Heart J
Levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study design of the levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery requiring cardiopulmonary bypass (LEVO-CTS) trial
Am Heart J
Postoperative complications of patients undergoing cardiac surgery
Curr Opin Crit Care
Epidemiology and outcome following post-surgical admission to critical care
Intensive Care Med
Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation. Analysis of a large, prospective, multicenter international registry
Circulation
Cardiac surgery in 260 octogenarians: A case series
BMC Anesthesiol
Frailty, aging, and cardiovascular surgery
Anesth Analg
Association between older age and outcome after cardiac surgery: A population-based cohort study
J Cardiothorac Surg
Outcome of cardiac surgery in patients with low preoperative ejection fraction
BMC Anesthesiol
Mortality reduction in cardiac anesthesia and intensive care: Results of the first International Consensus Conference
Acta Anaesthesiol Scand
Cited by (0)
M. Baiocchi, V. Lomivorotov, G. Monti, G. Paternoster, and H. Riha have received speaker fees from Orion Pharma, and G. Landoni has received speaker fees from AbbVie, Orion Pharma, Pall, and Tenax.