1. Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process
- Author
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Miriam Labonia, Rosalba Lembo, Cristiano Amarelli, Giuseppe Bono, Remo Daniel Covello, Nora Di Tomasso, Daniela Pasero, Hynek Riha, Anna Mara Scandroglio, Claudio Riefolo, Nesrin Ahu Aslan, Carlo Leggieri, Rosetta Lobreglio, Giovanni Landoni, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Gabriele Alvaro, Ludmilla Abrahao Hajjar, Alberto Zangrillo, Chiara Sartini, Martina Baiardo Redaelli, Massimo Baiocchi, Fabrizio Monaco, Giacomo Monti, Carmine D. Votta, Valentina Camarda, Paolo Mura, Evgeny Fominskiy, Alessandro Putzu, Emanuela Saporito, Antonio Pisano, Gianluca Paternoster, Rinaldo Bellomo, Simona Silvetti, Luca Brazzi, Giovanni Affronti, Stefano Turi, Agostino Roasio, Andrea Székely, Jun Ma, Caetano Nigro Neto, Landoni, Giovanni, Lomivorotov, Vladimir, Silvietti, Simona, Nigro Neto, Caetano, Pisano, Antonio, Alvaro, Gabriele, Hajjar, Ludmilla Abrahao, Paternoster, Gianluca, Riha, Hynek, Monaco, Fabrizio, Szekely, Andrea, Lembo, Rosalba, Aslan, Nesrin A., Affronti, Giovanni, Likhvantsev, Valery, Amarelli, Cristiano, Fominskiy, Evgeny, Baiardo Redaelli, Martina, Putzu, Alessandro, Baiocchi, Massimo, Ma, Jun, Bono, Giuseppe, Camarda, Valentina, Covello, Remo Daniel, Di Tomasso, Nora, Labonia, Miriam, Leggieri, Carlo, Lobreglio, Rosetta, Monti, Giacomo, Mura, Paolo, Scandroglio, Anna Mara, Pasero, Daniela, Turi, Stefano, Roasio, Agostino, Votta, Carmine D., Saporito, Emanuela, Riefolo, Claudio, Sartini, Chiara, Brazzi, Luca, Bellomo, Rinaldo, and Zangrillo, Alberto
- Subjects
medicine.medical_specialty ,Consensus ,Cardiac Surgery ,Consensus Development Conferences as Topic ,Psychological intervention ,MEDLINE ,Consensu ,Review ,030204 cardiovascular system & hematology ,Perioperative Care ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Anesthesiology ,Intensive care ,medicine ,Humans ,030212 general & internal medicine ,Perioperative ,Cardiac Surgical Procedures ,Mortality ,Intensive care medicine ,cardiac surgery ,consensus ,mortality ,mortality reduction ,perioperative ,review ,Cardiology and Cardiovascular Medicine ,Anesthesiology and Pain Medicine ,Randomized Controlled Trials as Topic ,Internet ,business.industry ,Congresses as Topic ,Cardiac surgery ,Mortality reduction ,Bypass surgery ,TERAPÊUTICA MÉDICA ,business ,Mortality Reduction - 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. Orion Pharma ; Abbott Laboratories ; Pall ; Tenax
- Published
- 2018