title: Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference.
abstract: There is no consensus on which drugs/techniques/strategies can affect mortality in the perioperative period of cardiac surgery. With the aim of identifying these measures, and suggesting measures for prioritized future investigation we performed the first International Consensus Conference on this topic. The consensus was a continuous international internet-based process with a final meeting on 28 June 2010 in Milan at the Vita-Salute University. Participants included 340 cardiac anesthesiologists, cardiac surgeons, and cardiologists from 65 countries all over the world. A comprehensive literature review was performed to identify topics that subsequently generated position statements for discussion, voting, and ranking. Of the 17 major topics with a documented mortality effect, seven were subsequently excluded after further evaluation due to concerns about clinical applicability and/or study methodology. The following topics are documented as reducing mortality: administration of insulin, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, the use of pre-operative intra-aortic balloon counterpulsation, and referral to high-volume centers. The following are documented as increasing mortality: administration of aprotinin and aged red blood cell transfusion. These interventions were classified according to the level of evidence and effect on mortality and a position statement was generated. This International Consensus Conference has identified the non-surgical interventions that merit urgent study to achieve further reductions in mortality after cardiac surgery: insulin, intra-aortic balloon counterpulsation, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, and referral to high-volume centers. The use of aprotinin and aged red blood cells may result in increased mortality.
authors.affiliation: Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy. landoni.giovanni@hsr.it
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.forename: J G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: F
authors.initials: F
authors.lastname: Guarracino
authors.forename: F
authors.initials: F
authors.lastname: Santini
authors.forename: M
authors.initials: M
authors.lastname: Ponschab
authors.forename: D
authors.initials: D
authors.lastname: Pasero
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
authors.forename: G
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: G
authors.initials: G
authors.lastname: Silvay
authors.forename: L
authors.initials: L
authors.lastname: Salvi
authors.forename: E
authors.initials: E
authors.lastname: Camporesi
authors.forename: M
authors.initials: M
authors.lastname: Comis
authors.forename: M
authors.initials: M
authors.lastname: Conte
authors.forename: S
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: L
authors.initials: L
authors.lastname: Cabrini
authors.forename: C
authors.initials: C
authors.lastname: Cariello
authors.forename: F
authors.initials: F
authors.lastname: Caramelli
authors.forename: V
authors.initials: V
authors.lastname: De Santis
authors.forename: P
authors.initials: P
authors.lastname: Del Sarto
authors.forename: D
authors.initials: D
authors.lastname: Dini
authors.forename: A
authors.initials: A
authors.lastname: Forti
authors.forename: N
authors.initials: N
authors.lastname: Galdieri
authors.forename: G
authors.initials: G
authors.lastname: Giordano
authors.forename: L
authors.initials: L
authors.lastname: Gottin
authors.forename: M
authors.initials: M
authors.lastname: Greco
authors.forename: E
authors.initials: E
authors.lastname: Maglioni
authors.forename: L
authors.initials: L
authors.lastname: Mantovani
authors.forename: A
authors.initials: A
authors.lastname: Manzato
authors.forename: M
authors.initials: M
authors.lastname: Meli
authors.forename: G
authors.initials: G
authors.lastname: Paternoster
authors.forename: D
authors.initials: D
authors.lastname: Pittarello
authors.forename: K N
authors.initials: KN
authors.lastname: Rana
authors.forename: L
authors.initials: L
authors.lastname: Ruggeri
authors.forename: V
authors.initials: V
authors.lastname: Salandin
authors.forename: F
authors.initials: F
authors.lastname: Sangalli
authors.forename: M
authors.initials: M
authors.lastname: Zambon
authors.forename: M
authors.initials: M
authors.lastname: Zucchetti
authors.forename: E
authors.initials: E
authors.lastname: Bignami
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000758:Anesthesia; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003422:Critical Care; D006801:Humans