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Published on: November 21, 2017
Effect of active warming on perioperative cardiovascular outcomes: a systematic review and meta-analysis of
Yunying Feng1,2,3, Yuelun Zhang4,5, Boyuan Sun3
1Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Insights
Active warming methods do not significantly impact major adverse cardiac events, 30-day mortality, or myocardial injury in noncardiac surgery patients. Current evidence suggests active warming is not necessary for cardiovascular prevention in this population.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Perioperative hypothermia is a common concern in noncardiac surgery.
- The role of active warming in preventing adverse cardiovascular outcomes remains debated.
- Existing guidelines offer varied recommendations on perioperative thermal management.
Approach:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searched multiple databases including MEDLINE, EMBASE, and Cochrane CENTRAL.
- Included RCTs comparing active warming to passive thermal management in adult noncardiac surgery patients.
Key Points:
- No significant difference was found in major adverse cardiac events (MACE), 30-day all-cause mortality, or myocardial injury between active warming and routine care.
- Meta-analysis results showed no statistically significant benefit of active warming.
- Trial sequential analysis indicated that current trials may not have reached sufficient sample size for definitive conclusions on cardiovascular events.
Conclusions:
- Active warming methods are not demonstrably necessary for cardiovascular prevention in patients undergoing noncardiac surgery.
- Routine perioperative care appears adequate for managing cardiovascular risks.
- Further research with larger sample sizes may be needed to confirm these findings.
Purpose:
The objective of this study was to provide an updated review on the active warming effects on major adverse cardiac events, 30-day all-cause mortality, and myocardial injury after noncardiac surgery.
Method:
We systematically searched MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Web of Science, and Chinese BioMedical Literature Database. We included randomized controlled trials of adult population undergoing noncardiac surgeries that concentrate on the comparison of active warming methods and passive thermal management. Cochrane Collaboration's tool was applied for risk-of-bias assessment. We used trial sequential analysis to evaluate the possibility of false positive or negative results.
Results:
A total of 13,316 unique records were identified, of which only 19 with reported perioperative cardiovascular outcomes were included in the systematic review and nine of them were included in final meta-analysis. No statistically significant difference between active warming methods and routine care was found in major adverse cardiac events (RR 0.56, 95% confidence interval (CI) 0.14-2.21, I2 = 71%, number of events 59 vs. 70), 30-day all-cause mortality (RR 0.81, 95% CI 0.43-1.54, I2 = 0%, number of events 17 vs. 21), and myocardial injury after noncardiac surgery (RR 0.61, 95% CI 0.17-2.22, I2 = 79%, number of events 236 vs. 234). Trial sequential analysis suggests that current trials did not reach the minimum information size regarding the major cardiovascular events.
Conclusions:
Compared to routine perioperative care, we found that active warming methods are not necessary for cardiovascular prevention in patients undergoing noncardiac surgery.
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