European Heart Journal Advance Access originally published online on July 28, 2008
European Heart Journal 2008 29(21):2592-2600; doi:10.1093/eurheartj/ehn333
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Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials
1 Division of Cardiac Surgery, McMaster University, 202-304 Victoria Avenue North, Hamilton, Ontario, Canada L8L 5G4
2 Division of Critical Care Medicine, McMaster University, Hamilton, Ontario, Canada
3 McMaster University, Hamilton, Ontario, Canada
4 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
6 Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
7 Copenhagen Trial Unit, Copenhagen University Hospital, Copenhagen, Denmark
Received 14 January 2008; revised 29 May 2008; accepted 25 June 2008; online publish-ahead-of-print 28 July 2008.
* Corresponding author. Tel: +1 905 527 4322, Fax: +1 905 523 4885, Email: rwhitlock{at}mountaincable.net
We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myocardial infarction, neurological events, new onset atrial fibrillation, transfusion requirements, postoperative bleeding, duration of ventilation, intensive care unit (ICU) stay, hospital stay, wound complications, gastrointestinal complications, and infectious complications. We included 44 trials randomizing 3205 patients. Steroids reduced new onset atrial fibrillation [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59 to 0.87], postoperative bleeding [weighted mean difference (WMD) –99.6 mL, 95% CI –149.8 to –49.3], and duration of ICU stay (WMD –0.23 days, 95% CI –0.40 to –0.07). Length of hospital stay was also reduced (WMD –0.59 days, 95% CI –1.17 to –0.02), but this result was less robust. A trend towards reduction in mortality was observed (RR 0.73, 95% CI 0.45 to 1.18). Randomized trials suggest that perioperative steroids have significant clinical benefit in CPB patients by decreasing the risk of new onset atrial fibrillation, while results are encouraging for reducing bleeding, length of stay, and mortality. These data do not raise major safety concerns, however, a sufficiently powered trial is warranted to confirm or refute these findings.
Key Words: Steroids • Cardiac surgery • Meta-analysis • Cardiopulmonary bypass • Inflammatory response • Clinical outcomes
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