1st International Consensus Conference
"Reduction in Mortality in Cardiac Anesthesia and Intensive Care"

Please agree or disagree with the following topics/statements/papers. You can still influence the final results of the consensus conference but you HAVE TO support your opinion with published evidence of statistically significant reduction/increase in mortality in cardiac anesthesia / intensive care.

Drugs/Techniques that can/might reduce mortality

B blockers
Scientific evidence: non-RCT
Effect on mortality: reduction
Data from a large cohort study suggest that pre-operative beta blockers reduce mortality in CABG patients without severe (EF<30%) LV dysfunction. Therefore beta blockers should not be discontinued prior to CABG. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Early aspirin after CABG
Scientific evidence: non-RCT
Effect on mortality: reduction
Early (6-48h) use of aspirin after CABG unless specifically contraindicated is safe and is associated with a reduction in mortality. The evidence comes from a non RCT. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

High-Volume Surgeon
Scientific evidence: non-RCT
Effect on mortality: reduction
Operative mortality in cardiac surgery appears to be related to surgeon volume. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Insuline (postoperatively)
Scientific evidence: RCT
Effect on mortality: reduction
A single centre randomized study demonstrated that maintaining a tight glycemic control with continuous insulin infusion can reduce mortality in critically ill patients, including post-cardiac surgery patients. However, subsequent evidence pointed out that aiming at an excessive tight glycemic control could potentially increase hypoglycemic episodes and mortality. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Intra Aortic Balloon Pump (IABP)
Scientific evidence: meta-analysis of RCTs
Effect on mortality: reduction
Pre-operative IABP might reduce mortality in elective high risk patients undergoing CABG unless specifically contraindicated. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Levosimendan
Scientific evidence: meta-analysis of RCTs
Effect on mortality: reduction
In a meta-analysis of pooled pre- and post-operative administration, Levosimendan seems to reduce mortality. However, there is not enough evidence to recommend its routine administration since statistical significance is lost when data are evaluated separately. Caution is advised in bolus administration. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Pexelizumab
Scientific evidence: meta-analysis of RCTs
Effect on mortality: reduction
Pexelizumab might reduce mortality in patients undergoing CABG. These findings come from a subgroup of a meta-analysis of RCTs and need further evaluation. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Statins
Scientific evidence: meta-analysis of RCT and non-RCTs
Effect on mortality: reduction
A meta-analysis of mostly non-RCTs in CABG suggested a reduction of mortality in patients receiving pre-operative statins. This topic merits further investigation. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Volatile anesthetics
Scientific evidence: meta-analysis of RCTs
Effect on mortality: reduction
Volatile anaesthetics can reduce 30-day mortality in hemodinamically stable patients undergoing CABG, as documented by a meta-analysis of RCTs. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Drugs/Techniques that can/might increase mortality

Aprotinin
Scientific evidence: RCT
Effect on mortality: increase
Despite the possibility of a modest reduction in massive bleeding, aprotinin increases mortality in high risk patients undergoing CCH. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials

Old (>15days) red blood cells transfusions
Scientific evidence: Non-RCT
Effect on mortality: increase
A large non-RCT suggests that transfusion of packed red blood cells stored for more than 15 days is associated with an increase of short and long term mortality. 		I agree
I disagree
I don't know
 comments

I have/had major or minor conflict of interest with this drug/technique or with competitors and/or I was an investigator of a clinical trial on this topics."conflict of interest" include: speaker fees,
employment, consultancies, stock ownership,
honoraria, paid expert testimony, accademic competition,
intellettual passion, personal relationship
"investigator" include: sponsored or
researcher driven trials
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