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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

10.01.2022 | Review Article/Brief Review

Morbidity and mortality in patients managed with high compared with low blood pressure targets during on-pump cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

verfasst von: Charlotte C. McEwen, MD, Takhliq Amir, BHSc(Hons), Yuan Qiu, BHSc(Hons), Jack Young, MLIS, Kevin Kennedy, MA, Hilary P. Grocott, MD, FRCPC, FASE, Hessam Kashani, MD, MSc, David Mazer, MD, FRCPC, Scott Brudney, MBChB, FRCPC, Morvarid Kavosh, MD, Eric Jacobsohn, MBChB, MPH, FRCPC, Anne Vedel, MD, PhD, Eugene Wang, MD, Richard P. Whitlock, MD, PhD, FRCSC, Emilie P. Belley-Coté, MD, PhD, FRCPC, Jessica Spence, MD, PhD, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 3/2022

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Abstract

Purpose

Many believe that blood pressure management during cardiac surgery is associated with postoperative outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the impact of high compared with low intraoperative blood pressure targets on postoperative morbidity and mortality in adults undergoing cardiac surgery on cardiopulmonary bypass (CPB). Our primary objective was to inform the design of a future large RCT.

Source

We searched MEDLINE, EMBASE, Web of Science, CINAHL, and CENTRAL for RCTs comparing high with low intraoperative blood pressure targets in adult patients undergoing any cardiac surgical procedure on CPB. We screened reference lists, grey literature, and conference proceedings.

Principal findings

We included eight RCTs (N =1,116 participants); all examined the effect of blood pressure management only during the CPB. Trial definitions of high compared with low blood pressure varied and, in some, there was a discrepancy between the target and achieved mean arterial pressure. We observed no difference in delirium, cognitive decline, stroke, acute kidney injury, or mortality between high and low blood pressure targets (very-low to low quality evidence). Higher blood pressure targets may have increased the risk of requiring a blood transfusion (three trials; n = 456 participants; relative risk, 1.4; 95% confidence interval, 1.1 to 1.9; P = 0.01; moderate quality evidence) but this finding was based on a small number of trials.

Conclusion

Individual trial definitions of high and low blood pressure targets varied, limiting inferences. The effect of high (compared with low) blood pressure targets on other morbidity and mortality after cardiac surgery remains unclear because of limitations with the body of existing evidence. Research to determine the optimal management of blood pressure during cardiac surgery is required.

Study registration

PROSPERO (CRD42020177376); registered: 5 July 2020.

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Titel: Morbidity and mortality in patients managed with high compared with low blood pressure targets during on-pump cardiac surgery: a systematic review and meta-analysis of randomized controlled trials
verfasst von: Charlotte C. McEwen, MD
Takhliq Amir, BHSc(Hons)
Yuan Qiu, BHSc(Hons)
Jack Young, MLIS
Kevin Kennedy, MA
Hilary P. Grocott, MD, FRCPC, FASE
Hessam Kashani, MD, MSc
David Mazer, MD, FRCPC
Scott Brudney, MBChB, FRCPC
Morvarid Kavosh, MD
Eric Jacobsohn, MBChB, MPH, FRCPC
Anne Vedel, MD, PhD
Eugene Wang, MD
Richard P. Whitlock, MD, PhD, FRCSC
Emilie P. Belley-Coté, MD, PhD, FRCPC
Jessica Spence, MD, PhD, FRCPC
Publikationsdatum: 10.01.2022
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 3/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-021-02171-3

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Morbidity and mortality in patients managed with high compared with low blood pressure targets during on-pump cardiac surgery: a systematic review and meta-analysis of randomized controlled trials