scholarly journals Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

2022 ◽  
pp. 021849232110691
Author(s):  
Imthiaz Manoly ◽  
Mohsin Uzzaman ◽  
Dimos Karangelis ◽  
Manoj Kuduvalli ◽  
Efstratios Georgakarakos ◽  
...  
Keyword(s):  
Renal Failure ◽  
Hospital Stay ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hypothermic Circulatory Arrest ◽  
Transfusion Requirements ◽  
Secondary Outcomes

Objective Deep hypothermic circulatory arrest (DHCA) in aortic surgery is associated with morbidity and mortality despite evolving strategies. With the advent of antegrade cerebral perfusion (ACP), moderate hypothermic circulatory arrest (MHCA) was reported to have better outcomes than DHCA. There is no standardised guideline or consensus regarding the hypothermic strategies to be employed in open aortic surgery. Meta-analysis was performed comparing DHCA with MHCA + ACP in patients having aortic surgery. Methods A systematic review of the literature was undertaken. Any studies with DHCA versus MHCA + ACP in aortic surgeries were selected according to specific inclusion criteria and analysed to generate summative data. Statistical analysis was performed using STATS Direct. The primary outcomes were hospital mortality and post-operative stroke. Secondary outcomes were cardiopulmonary bypass time (CPB), post-operative blood transfusion, length of ICU stay, respiratory complications, renal failure and length of hospital stay. Subgroup analysis of primary outcomes for Arch surgery alone was also performed. Results Fifteen studies were included with a total of 5869 patients. There was significantly reduced mortality (Pooled OR = +0.64, 95% CI = +0.49 to +0.83; p = 0.0006) and stroke rate (Pooled OR = +0.62, 95% CI = +0.49 to +0.79; p < 0.001) in the MHCA group. MHCA was associated significantly with shorter CPB times, shorter duration in ICU, less pulmonary complications, and reduced rates of sepsis. There was no statistical difference between the two groups in terms of circulatory arrest times, X-Clamp times, total operation duration, transfusion requirements, renal failure and post-op hospital stay. Conclusion MHCA + ACP are associated with significantly better post-operative outcomes compared with DHCA for both mortality and stroke and majority of the secondary outcomes.

Evaluating the Quality of Trials of Hypothermic Circulatory Arrest Aortic Surgery

2007 ◽  
Vol 15 (5) ◽  
pp. 449-452 ◽  
Author(s):  
Jeffrey H Shuhaiber
Keyword(s):  
Randomized Controlled Trials ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Neurological Deficits ◽  
Controlled Trials ◽  
Randomized Controlled

The quality of level 1 evidence in reports on deep hypothermic circulatory arrest was assessed, and the confounding factors in surgical management and study design that can prevent meta-analysis formulation were determined. A systematic search of the literature was conducted using categorized nomenclature for randomized controlled trials in adult patients undergoing deep hypothermic circulatory arrest in the last 40 years. Twelve randomized controlled trials (2.3%) were found among 504 publications on deep hypothermic circulatory arrest listed on Medline from 1960; only 4 of them related to adults. One adequately powered study demonstrated reduced blood loss in deep hypothermic circulatory arrest using aprotinin. Three studies comparing retrograde and antegrade perfusion were underpowered. The median CONSORT score was 14 (range, 13–15). There were no consistent measures of similar outcomes (neuropsychometric, neurocognitive). No explanation was provided for the difference in reported ranges of neurological deficits in nonrandomized (5%–70%) and randomized (3%–9%) studies. Existing studies of deep hypothermic circulatory arrest are insufficient and inconsistent in the outcome measured, which explains the lack of a meta-analysis. Neurological injury remains high, and an appropriately powered study of interventions that can optimize cerebral perfusion is necessary.

Haemadsorption improves intraoperative haemodynamics and metabolic changes during aortic surgery with hypothermic circulatory arrest

2019 ◽  
Vol 56 (4) ◽  
pp. 731-737
Author(s):  
Thomas Saller ◽  
Christian Hagl ◽  
Stefan Woitsch ◽  
Yupeng Li ◽  
Sebastian Niedermayer ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Hypothermic Circulatory Arrest ◽  
Acid Base Balance ◽  
Acid Base ◽  
Packed Red Blood Cells ◽  
Base Balance

Abstract OBJECTIVES: Aortic surgery involving hypothermic circulatory arrest (HCA) results in a systemic inflammatory response that may negatively influence outcome. An extracorporeal haemadsorption (HA) device (CytoSorb®) that removes inflammatory triggers may improve haemodynamic and metabolic reactions due to excessive inflammation and, ultimately, outcome. METHODS: As a single-centre experience, the data of 336 patients who had undergone aortic surgery with HCA between 2013 and 2017 were retrospectively analysed. Patients with HA were matched to patients receiving standard therapy without HA (Control) by propensity score matching and compared subsequently. RESULTS: During aortic surgery with HCA, HA significantly reduced the requirement of norepinephrine (HA: 0.102 µg/kg/min; Control: 0.113; P = 0.043). Severe disturbances of acid–base balance as reflected by a pH lower than 7.19 (HA: 7.1%; Control: 11.6%; P = 0.139), maximum lactate concentrations (HA: 3.75 mmol/l; Control: 4.23 P = 0.078) and the need for tris-hydroxymethylaminomethane buffer (HA: 6.5%; Control: 13.7%; P = 0.045) were less frequent with HA. Compared to standard therapy, HA decreased the need for transfusion of packed red blood cells (1 unit; P = 0.021) and fresh frozen plasma (3 units; P = 0.001), but increased the requirement of prothrombin complex concentrate (800 IE, P = 0.0036). HA did not affect inflammatory laboratory markers on the first postoperative day. Differences in operative mortality (HA: 4.8%; Control: 8.8%) and the length of hospital stay (HA: 13.5 days; Control: 14) were not statistically significant. CONCLUSIONS: HA significantly reduces the need for vasopressors, the amount of transfusion and improves acid–base balance in aortic surgery with HCA. Multicentre prospective trials are required to confirm these results.

scholarly journals Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Yulin Guo ◽  
Feng Cao ◽  
Yixuan Ding ◽  
Haichen Sun ◽  
Shuang Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Gastrointestinal Surgery ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Intraoperative Blood Loss

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

Effect of dexmedetomidine on lung function and prognosis a systematic review and meta-analysis

2020 ◽  
Author(s):  
Bingcheng Chen ◽  
Jing Yang ◽  
Guoliang Sun ◽  
Weifeng Yao ◽  
Ziqing Hei
Keyword(s):  
Systematic Review ◽  
Lung Function ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Cochrane Library ◽  
Extubation Time ◽  
Significant Difference ◽  
Respiratory Index

Abstract Background: This systematic review and meta-analysis aimed to evaluate the effect of dexmedetomidine on lung function and prognosis.Methods: We searched PubMed, Embase and the Cochrane Library from inception to January 30, 2020 following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Randomized controlled trials of dexmedetomidine associated with lung function were assessed. The primary outcomes are pH, PaO2, PaCO2, respiratory index (RI) and time to extubation. The secondary outcomes are PaO2/FiO2, length of hospital stay and events of pulmonary complications.Results: 17 trials of 924 patients were included. Compared with placebo group, dexmedetomidine group had higher PaO2 (MD: 10.96; 95% CI: from 0.77 to 21.15; p=0.04) and PaO2/FiO2 (MD: 30.77; 95% CI: from 19.11 to 42.43; p<0.00001). The dexmedetomidine group had lower PaCO2 (MD: -0.88; 95% CI: from -1.66 to -0.11; p=0.002) and shorter length of hospital stay (MD: -1.19; 95% CI: from -2.21 to -0.16; p=0.02). The dexmedetomidine group had lower occurrence of pulmonary complications (RR: 0.28; 95% CI: from 0.09 to 0.82; p=0.02). However, there is no significant difference in pH, respiratory index and extubation time.Conclusion: Dexmedetomidine has better influence on lung function and prognosis.

scholarly journals Effect of Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermic Circulatory Arrest in Aortic Arch Surgery on Postoperative Renal Function: A Systematic Review and Meta‐Analysis

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Liang Cao ◽  
Xiaoxiao Guo ◽  
Yuan Jia ◽  
Lijing Yang ◽  
Hongbai Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Renal Function ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Surgery ◽  
Postoperative Renal Function

Background Moderate hypothermic circulatory arrest (MHCA) has been widely used in aortic arch surgery. However, the renal function after MHCA remains controversial. We performed a systematic review and meta‐analysis direct comparison of the postoperative renal function of MHCA versus deep hypothermic circulatory arrest (DHCA) in aortic arch surgery. Methods and Results We searched PubMed, Embase, and the Cochrane Library for postoperative renal function after aortic arch surgery with using MHCA and DHCA, published from inception to January 31, 2020. The primary outcome was renal failure. Secondary outcomes were the need for renal therapy and other major postoperative outcomes. The random‐effects model was used for all comparisons to pool the estimates. A total of 14 observational studies with 4142 patients were included. Compared with DHCA, MHCA significantly reduced the incidence of renal failure (odds ratio [OR], 0.76; 95% CI, 0.61–0.94; P =0.011; I 2 =0.0%) and the need of renal replacement (OR, 0.68; 95% CI, 0.48–0.97; P =0.034; I 2 =0.0%). Subgroup analysis showed that when the hypothermic circulatory arrest time was <30 minutes, the incidence of renal failure in MHCA group was significantly lower than that in DHCA group (OR, 0.73; 95% CI, 0.54–0.99; P =0.040; I 2 =1.1%), whereas an insignificant difference between 2 groups when hypothermic circulatory arrest time was >30 minutes (OR, 0.76; 95% CI, 0.51–1.13; P =0.169; I 2 =17.3%). Conclusions MHCA compared with DHCA reduces the incidence of renal failure and the need for renal replacement. Registration URL: https://www.crd.york.ac.uk/prospero ; Unique identifier: CRD42020169348.

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