Enhanced recovery after cardiac surgery under CPB or off-pump 2021

Objective > To provide recommendations for Enhanced Recovery After Cardiac Surgery (ERACS) based on a multimodal approach of perioperative medicine of adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity and reducing length of hospital stays.Design > A consensus committee of 20 experts from the French society of anaesthesiology and critical care medicine (Societe francaise d'anesthesie-reanimation, SFAR) and the French society of thoracic and cardio-vascular surgery (Societe francaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assess-ment of quality of evidence.Methods > Six fields were defined: 1) selection of the patient pathway and their information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for cardiac surgery; 4) surgical strategy for cardiac surgery and bypass management; 5) Patient Blood Management; and 6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analysed using the GRADE approach. The recommendations were formulated according to the GRADE methodology, and then voted by all the experts according to the GRADE grid method.Results > The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing pulmonary lobectomy. After three rounds of voting and several amend-ments, a strong agreement was reached for 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert judgments. Finally, no recommenda-tion was provided for 3 questions. Conclusions > Strong agreement exists among the experts to provide recommendations to opti-mize the whole perioperative management of patients undergoing cardiac surgery.

Automated summary

This study provides recommendations for Enhanced Recovery After Cardiac Surgery (ERACS) using a multimodal approach of perioperative medicine. The aim is to improve patient satisfaction, reduce postoperative mortality and morbidity, and decrease length of hospital stays. 33 recommendations were agreed upon by a panel of experts, based on extensive research and analysis.