Abstract
According to the EUSOS study, perioperative mortality for noncardiac surgery is 1–4 % [1], considering that up to 230 million surgical procedures are performed each year in the world [2], even a small reduction would have a tremendous impact on public health.
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Summary of the New Evidences
Summary of the New Evidences
New topic | Intervention | Author | Control | Setting | N of RCT | N of patients | Size effect | Notes |
|---|---|---|---|---|---|---|---|---|
Yes | Miniaturized extracorporeal circulation | Kowalewski M | Conventional extracorporeal circulation | CABG | 134 | 22,778 | OR 0.46 (95 % CI 0.22–0.91) | Network meta- analysis, comparing also off-pump CABG |
Vasopressin, terlipressin or methylene blue | Belletti A | Placebo or norepinephrine or dopamine or standard treatment | Vasodilatatory shock (cardiac surgery/critically ill (sepsis)) | 20 | 1,608 | RR 0.88 (95 % CI 0.79–0.98) | Multiple comparators Mixed population | |
Perioperative goal-directed hemodynamic therapy | Ripollés-Melchor J | Conventional fluid therapy | Noncardiac surgery | 10 | 1,527 | RR 0.63 (95 % CI 0.42–0.94) | ||
No | Volatile agents | Zangrillo A | TIVA | CCH | 55 | 6,921 | OR 0.56 (95 % CI 0.36–0.88) | Network meta-analysis (volatile, TIVA ± RIPC). Significant effect in direct comparison for volatile vs TIVA (36 studies, 3,680 patients) |
Preoperative IABP | Poirier Y | No intervention | CCH | 11 | 1,293 | OR 0.20 (95 % CI 0.09–0.44) | Observational studies were included, but were analyzed separately | |
Pilarczyk K | No intervention | CCH | 9 | 1,171 | OR 0.38 (95 % CI 0.23–0.63) | |||
Levosimendan | Zhou C | Placebo or dobutamine or milrinone | CCH | 13 | 1,254 | OR 0.43 (95 % CI 0.25–0.76) | Multiple comparators | |
Qiao L | Placebo or dobutamine or milrinone | CABG(high-risk surgical patients) | 10 | 440 | OR 0.35 (95 % CI 0.18–0.71) | Multiple comparators | ||
Remote ischemic preconditioning | Le Page S | No intervention | CCH and interventional cardiology | 44 | 5,317 | OR 0.27 (95 % CI 0.13–0.58) | Mixed population. Long -term mortality was reported only in three RCTs (383 patients) |
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Mucchetti, M., Landoni, G. (2017). Reducing Mortality in the Perioperative Period: A Continuous Update. In: Landoni, G., Ruggeri, L., Zangrillo, A. (eds) Reducing Mortality in the Perioperative Period. Springer, Cham. https://doi.org/10.1007/978-3-319-46696-5_18
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