Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference

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 internetbased
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 b-blockade, early aspirin therapy, the use of pre-operative
intra-aortic balloon counterpulsation, and referral to highvolume
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 b-blockade, early aspirin
therapy, and referral to high-volume centers. The use of aprotinin
and aged red blood cells may result in increased mortality.