Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump - 15/06/22

Doi : 10.1016/j.accpm.2022.101059

Paul-Michel Mertes ^a,^{^{1
The two first authors have contributed equally to the editing process.}}, Michel Kindo ^b,^{^{1
The two first authors have contributed equally to the editing process.}}, Julien Amour ^c, Christophe Baufreton ^d,^e, Lionel Camilleri ^f, Thierry Caus ^g, Didier Chatel ^h, Bernard Cholley ⁱ, Alain Curtil ^j, Jean-Philippe Grimaud ^k, Rémi Houel ^l, Fehmi Kattou ^m, Jean-Luc Fellahi ^n,^o, Catherine Guidon ^p, Pierre-Grégoire Guinot ^q,^r,^s,^t, Guillaume Lebreton ^u, Sandrine Marguerite ^a, Alexandre Ouattara ^v,^w, Sophie Provenchère Fruithiot ^x,^y, Bertrand Rozec ^z,^A, Jean-Philippe Verhoye ^B, André Vincentelli ^C, Hélène Charbonneau ^D,^⁎
^a Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
^b Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
^c Institut de Perfusion, de Réanimation, d’Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
^d Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France
^e MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
^f Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
^g Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
^h Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
ⁱ Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
^j Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
^k Department of Cardiac Surgery, Clinique Saint Augustin, Bordeaux, France
^l Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
^m Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
ⁿ Service d’Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France
^o Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
^p Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
^q Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
^r University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France
^s INSERM, LNC UMR1231, Dijon, France
^t FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
^u Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
^v CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France
^w Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
^x Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France
^y Centre d’Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
^z Service d’Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France
^A Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
^B Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
^C Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
^D Anesthésie Réanimation, Clinique Pasteur, Toulouse, France

^⁎Corresponding author at: 45, Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 03, France.45, Avenue de LombezBP 27617Toulouse Cedex 0331076France

Abstract

Objective

To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay.

Design

A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.

Methods

Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method.

Results

The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1−); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2−); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions.

Conclusions

Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.

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Keywords : Cardiac surgery, Enhanced recovery after surgery (ERAS), Guidelines, Cardiopulmonary bypass, off pump cardiac surgery

Plan

Fields of recommendations

Summary of the results

SFAR experts’ conflicts of interest during the five years preceding the date of validation by SFAR Board of Directors

SFCTCV experts’ conflicts of interest during the five years preceding the date of validation by the SFCTCV Board of Directors

☆	Validated by the SFAR Clinical Practice Guidelines Committee on the 10th of May 2021, the SFAR Board of Directors on the 19th of May 2021, and the SFCTCV Board of Directors on the 05th of June 2021.
☆☆	Clinical guidelines issued by the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire).

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Vol 41 - N° 3

Article 101059- juin 2022 Retour au numéro

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Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump - 15/06/22

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