Giovanni Landoni1, Vladimir Lomivorotov2, Simona Silvetti3, Caetano Nigro Neto4, Antonio Pisano5, Gabriele Alvaro6, Ludmilla Abrahao Hajjar7, Gianluca Paternoster8, Hynek Riha9, Fabrizio Monaco3, Andrea Szekely10, Rosalba Lembo3, Nesrin A Aslan11, Giovanni Affronti3, Valery Likhvantsev12, Cristiano Amarelli13, Evgeny Fominskiy2, Martina Baiardo Redaelli3, Alessandro Putzu14, Massimo Baiocchi15, Jun Ma16, Giuseppe Bono6, Valentina Camarda3, Remo Daniel Covello17, Nora Di Tomasso3, Miriam Labonia6, Carlo Leggieri3, Rosetta Lobreglio18, Giacomo Monti3, Paolo Mura19, Anna Mara Scandroglio3, Daniela Pasero18, Stefano Turi3, Agostino Roasio20, Carmine D Votta3, Emanuela Saporito6, Claudio Riefolo3, Chiara Sartini3, Luca Brazzi21, Rinaldo Bellomo22, Alberto Zangrillo23. 1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it. 2. Department of Anaesthesiology and Intensive Care, Siberian Biomedical Research Center of the Ministry of Health, Novosibirsk, Russia. 3. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. 5. Division of Cardiac Anesthesia and Intensive Care, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy. 6. Department of Anesthesia and Intensive Care, Policlinico Universitario Mater Domini, Catanzaro, Italy. 7. Surgical Intensive Care, Department of Cardiopneumology, InCor, University of São Paulo. São Paulo, Brazil. 8. Department of Cardiovascular Anaesthesia and Intensive Care, Ospedale San Carlo, Potenza, Italy. 9. Cardiothoracic Anaesthesiology and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 10. Department of Anesthesia and Intensive Care, Semmelweis Egyetem, Budapest, Hungary. 11. Medipol Mega University Hospital, Department of Anesthesiology and Intensive Care, Istanbul, Turkey. 12. Department of Anesthesia and Intensive Care, Moscow Regional Clinical and Research Institute, Moscow, Russia. 13. Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy. 14. Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland. 15. Department of Anesthesia and Intensive Care, S. Orsola-Malpighi University Hospital, Bologna, Italy. 16. Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China. 17. Anesthesia and Intensive Care Unit, Busto Arsizio Hospital, ASST Valle Olona, Varese, Italy. 18. Department of Anesthesia and Intensive Care, A.O.U. Città della Salute e della Scienza, Turin, Italy. 19. Department of Anesthesia and Intensive Care Unit, Policlinico Duilio Casula AOU Cagliari, Department of Medical Sciences "M. Aresu," Cagliari, Italy. 20. Department of Anaesthesia and Intensive Care, Ospedale Cardinal Massaia di Asti, Asti, Italy. 21. Department of Anesthesia and Intensive Care, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Surgical Sciences, University of Turin, Italy. 22. School of Medicine, The University of Melbourne, Parkville, Melbourne, Australia. 23. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Abstract
OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.
OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.
Authors: Islam Mohammad Shehata; Tiffany D Odell; Amir Elhassan; Maxim Spektor; Ivan Urits; Omar Viswanath; George M Jeha; Elyse M Cornett; Alan D Kaye Journal: Cardiol Ther Date: 2020-12-23