Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP)

Margarit, A. S.; Pajares, María Azucena; García-Camacho, Carlos; Castaño, Mario; Gómez, M.; García-Suárez, Jessica; Soto-Viudez, María José; López-Menéndez, José; Martín-Gutiérrez, Elio; Blanco-Morillo, Juan; Mateo, E.; Hernández-Acuña, Carlos; Vives, Marc; Llorens, R.; Fernández-Cruz, Jesús; Acosta, J.; Pradas-Irún, Concepción; García, Mercedes; Aguilar-Blanco, Eva María; Castaño, Beatriz; López, Sara; Bel, A.; Gabaldón, Tania; Fernández-López, A.; Gutiérrez‐Carretero, Encarnación; López-Forte, Cristina; Moreno, Jesús; Galán, J.; Osseyran, Faisa; Bustamante‐Munguira, Juan; Veiras, S.; Vicente, R.

doi:10.1016/j.circv.2020.11.004

Cited by 3 publications

(6 citation statements)

References 430 publications

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“…However, current evidence supporting the individual benefits of the CPB initiation with an empty venous line or VAVD, in terms of enhanced recovery, is also poor [ 1 , 25 , 26 ]. Otherwise, our observations indicate that when all these techniques are combined in the standardized procedure described as HAR, priming hemodilution and BPR until hospital discharge are reduced until hospital discharge, representing a significant effect on the recovery.…”

Section: Discussionmentioning

confidence: 99%

“…The new era of cardiac surgery has changed the paradigm of obtaining an acceptable survival rate to the adoption of Enhanced Recovery After Cardiac Surgery (ERACS) programs to reinforce every step of the perioperative procedure to augment the efficiency of cardiac surgery processes. Thus, the recommended intraoperative interventions are mainly oriented to maintaining temperature, glycemia, and oxygenation within a physiological range [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Minimally invasive extracorporeal circuits (MiECC) and repriming techniques like retrograde autologous priming (RAP) have been strongly recommended for blood-saving [ 1 , 4 , 5 ]. However, methodological weakness in current studies and heterogeneity between authors in the application of both is a matter of concern [ 6 – 11 ] about its beneficial effect in terms of the whole process.…”

Section: Introductionmentioning

confidence: 99%

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Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

Blanco-Morillo

Salmerón-Martínez

Arribas

et al. 2023

J Extra Corpor Technol

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Background: New era of cardiac surgery aims to provide an enhanced postoperative recovery by the implementation of every step of the process. Thus, perfusion strategy should adopt evidence-based measures to reduce the impact of cardiopulmonary bypass (CPB). Hematic Antegrade Repriming (HAR) provides a standardized procedure combining several measures to reduce haemodilutional priming to 300 mL. Once the safety of the procedure in terms of embolic release has been proven, the evaluation of its beneficial effects in terms of transfusion and ICU stay should be assessed to determine if could be considered for inclusion in Enhanced Recovery After Cardiac Surgery (ERACS) programs. Methods: Two retrospective and non-randomized cohorts of high-risk patients, with similar characteristics, were assessed with a propensity score matching model. The treatment group (HG) (n=225) received the HAR. A historical cohort, exposed to a conventional priming with 1350 mL of crystalloid conformed the control group (CG) (n=210). Results: Exposure to any transfusion was lower in treated (66,75% vs 6,88%, p<0.01). Prolonged mechanical ventilation (>10h) (26.51% vs 12.62%; p<0.01) and extended ICU stay (>2d) (47.47% vs 31.19%; p<0.01) were fewer for treated. HAR did not increase early morbidity and mortality. Related savings varied from 581 to 2741.94 $/patient, depending on if direct or global expenses were considered. Discussion: By reducing the gaseous and crystalloid emboli during CPB initiation, HAR seem to have a beneficial impact in recovery and reduces the overall transfusion until discharge, leading to significant cost savings per process. Due to the preliminary and retrospective nature of the research and limitations, our findings should be validated by future prospective and randomized studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

Blanco-Morillo

Salmerón-Martínez

Arribas

et al. 2023

J Extra Corpor Technol

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“…Early extubation after cardiac surgery, when possible, improves outcomes in terms of morbidity and mortality compared with late extubation [ 1 , 10 ]. The early discontinuation of mechanical is associated with a reduction in pulmonary complications, hospital stay, reintubation, arrhythmias, etc.…”

Section: Discussionmentioning

confidence: 99%

“…A consensus document published in 2021 by different scientific societies in our country strongly recommended [ 10 ] extubation in the first 6 postoperative hours, whereas extubation in the operating room was only advised based individual patient assessment.…”

Section: Introductionmentioning

confidence: 99%

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Carnero-Alcázar,

Beltrao-Sial,

Montero-Cruces

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES We aimed at comparing the risk of major adverse events and length of stay between patients undergoing ultrafast track and conventional fast track. METHODS Retrospective cohort study adjusted by propensity score matching, including patients operated on between March 2020 and December 2022 of any of the following: coronary, valve surgery or ascending aorta surgery. Patients were divided into 2 groups: ultrafast track: extubation in the operating room and fast track: extubation attempted in the first 6 postoperative hours. The primary objective was to compare the risk of the combined event death, lung respiratory outcomes (reintubation, mechanical ventilation longer than 24 h or pneumonia), or acute renal failure. RESULTS A total of 1126 patients were included. A total of 579 (51.4%) were extubated in the operating room. A total of 331 pairs were available after matching by propensity score. The risk of the primary outcome was 11.8% (n = 39) in the fast-track group and 6.3% (n = 21) in the ultrafast-track group (P = 0.013), mostly driven by lung adverse events (6.9% vs 2.4%, P = 0.011) while no significant differences were detected in the risk of death (2.4% vs 1.8%, P = 0.77) or acute renal failure (8% vs 6.3%, P = 0.56). The risk of myocardial infarction was higher in the fast-track group (2.7% vs 0%, P = 0.039). The median length of stay in the postoperative intensive care unit was longer in the fast-track group [24.7 h (interquartile range 21.5; 62.9) vs 23.5 h (interquartile range 22; 46), P = 0.015]. CONCLUSIONS In patients undergoing cardiac surgery, extubation in the operating room is associated to a lower risk of postoperative complications (mostly driven by lung adverse events) and length of stay in intensive care unit as compared to fast track.

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2023

Rev Argent Cardiol

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ADaurícula derecha ACM asistencia circulatoria mecanica ACV accidente cerebro vascular ACVi accidente cerebro vascular isquémico ASPECTS-Alberta Stroke Program Early CT Score / Score del Programa de Tomografia Temprana en el ACV de Alberta AESP actividad eléctrica sin pulso AINE(AINES) antiinflamatorios no esteroides AL ácido láctico ARM asistencia respiratoria mecánica AVM asistencia ventilatoria mecánica ATC angioplastia transluminal coronaria ATP adenosina trifosfato AVK antagonistas de la vitamina K BCIA balón de contrapulsación intraaórtico BNP Peptido Natriurético tipo B CAP catéter de arteria pulmonar

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Cited by 3 publications

References 430 publications

Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

Haematic antegrade repriming to enhance recovery after cardiac surgery from the perfusionist side

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

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