Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis.
Omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation is an attractive therapeutic option for patients undergoing open-heart surgery due to their anti-inflammatory and anti-arrhythmic properties. Several randomized controlled trials (RCT) have found contradictory results for perioperative ω-3 PUFA administration. Therefore, we conducted an updated systematic review and meta-analysis evaluating the effects of perioperative ω-3 PUFA on some clinically important outcomes for cardiac surgery.



A systematic literature search was conducted to find RCT evaluating clinical outcomes after ω-3 PUFA therapy in adult patients undergoing cardiac surgery. Intensive care unit (ICU) length of stay (LOS) was the primary outcome; secondary outcomes were hospital LOS, postoperative atrial fibrillation (POAF), mortality and duration of mechanical ventilation (MV). Predefined subgroup analysis and sensibility analysis were performed.



A total of 19 RCT including 4335 patients met inclusion criteria. No effect of ω-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95% confidence interval, CI -10.28 to 4.39, P = 0.43). However, ω-3 PUFA reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No effects were found on mortality or MV duration. Heterogeneity remained in subgroup analysis and we found a significant POAF reduction when ω-3 PUFA doses were administered to patients exposed to extra-corporeal circulation. Oral/enteral administration seemed to further reduce POAF.



In patients undergoing cardiac surgery, ω-3 PUFA supplementation by oral/enteral and parenteral route reduces hospital LOS and POAF. Nonetheless considerable clinical and statistical heterogeneity weaken our findings.
Department of Anesthesiology and Reanimation, Faculty of Medicine and Health Sciences, Sherbrooke University Hospital, Sherbrooke, Québec, Canada. Electronic address: Pascal.laferriere-langlois@usherbrooke.ca.
Pascal L
PL
Langlois
Ipanema Research Trust, Auckland, New Zealand.
Gil
G
Hardy
Department of Critical Care, Intensive Care Unit, University Hospital, Faculty of Medicine, UDELAR, Montevideo, Uruguay.
William
W
Manzanares
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control; D006348:Cardiac Surgical Procedures; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D019990:Perioperative Care; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D016896:Treatment Outcome
D015525:Fatty Acids, Omega-3
Atrial fibrillation; Cardiac surgery; Meta-analysis; Omega-3 polyunsaturated fatty acids