Objective: There isexperimentalevidencethatphosphocreatine(PCr)candecreaseischemia/reperfusioninjuryoftheheart.Theauthors investigated ifPCrwouldimproveheartperformanceascomparedwithstandardtreatmentincardiacsurgery. Design: Meta-analysis ofrandomizedcontrolledtrials. Setting: Hospitals. Participants: Adult andpediatricpatientsundergoingcardiacsurgery. Interventions: The abilityofPCrtoimprovecardiacoutcomesascomparedwithstandardtreatmentwasinvestigated. Measurements andMainResults: PubMed/Medline, Embase,Scopus,CochraneLibrary,ChinaNationalKnowledgeInfrastructure, WANGFANG DATA,andVIPPaperCheckSystemweresearchedtoMarch12017.Theauthorsincluded26randomizedcontrolledtrials comprising 1,948patients.Randomand fixed-effects modelswereusedtoestimateoddsratio(OR)andmeandifference(MD)with95% confidence interval(CI).PCrusewasassociatedwithreducedratesofintraoperativeinotropicsupport(27% v 44%; OR0.47,95%CI0.35-0.61; p o 0.001), majorarrhythmias(16% v 28%; OR0.44,95%CI0.27-0.69;p o 0.001), aswellasincreasedspontaneousrecoveryofthecardiac rhythm immediatelyafteraorticdeclamping(50% v 34%; OR2.45,95%CI1.82-3.30;p o 0.001) ascomparedwithstandardtreatment.The use ofPCrdecreasedmyocardialdamageandaugmentedleftventricularejectionfractioninthepostoperativeperiod;however,MDforthese outcomes weresmallanddonotseemtobeclinicallysignificant. Conclusions: In randomizedtrials,PCradministrationwasassociatedwithreducedratesofintraoperativeinotropicsupportandmajorarrhythmias, andincreasedspontaneousrecoveryofthecardiacrhythmafteraorticdeclamping.Largemulticenterevidenceisneededtovalidatethese findings
Mingxing, F., Landoni, G., Zangrillo, A., Monaco, F., Lomivorotov, V.v., Hui, C., et al. (2018). Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized Controlled Trials. JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 32(2), 762-770 [10.1053/j.jvca.2017.07.024].
Phosphocreatine in Cardiac Surgery Patients: A Meta-Analysis of Randomized Controlled Trials
Monaco F;
2018
Abstract
Objective: There isexperimentalevidencethatphosphocreatine(PCr)candecreaseischemia/reperfusioninjuryoftheheart.Theauthors investigated ifPCrwouldimproveheartperformanceascomparedwithstandardtreatmentincardiacsurgery. Design: Meta-analysis ofrandomizedcontrolledtrials. Setting: Hospitals. Participants: Adult andpediatricpatientsundergoingcardiacsurgery. Interventions: The abilityofPCrtoimprovecardiacoutcomesascomparedwithstandardtreatmentwasinvestigated. Measurements andMainResults: PubMed/Medline, Embase,Scopus,CochraneLibrary,ChinaNationalKnowledgeInfrastructure, WANGFANG DATA,andVIPPaperCheckSystemweresearchedtoMarch12017.Theauthorsincluded26randomizedcontrolledtrials comprising 1,948patients.Randomand fixed-effects modelswereusedtoestimateoddsratio(OR)andmeandifference(MD)with95% confidence interval(CI).PCrusewasassociatedwithreducedratesofintraoperativeinotropicsupport(27% v 44%; OR0.47,95%CI0.35-0.61; p o 0.001), majorarrhythmias(16% v 28%; OR0.44,95%CI0.27-0.69;p o 0.001), aswellasincreasedspontaneousrecoveryofthecardiac rhythm immediatelyafteraorticdeclamping(50% v 34%; OR2.45,95%CI1.82-3.30;p o 0.001) ascomparedwithstandardtreatment.The use ofPCrdecreasedmyocardialdamageandaugmentedleftventricularejectionfractioninthepostoperativeperiod;however,MDforthese outcomes weresmallanddonotseemtobeclinicallysignificant. Conclusions: In randomizedtrials,PCradministrationwasassociatedwithreducedratesofintraoperativeinotropicsupportandmajorarrhythmias, andincreasedspontaneousrecoveryofthecardiacrhythmafteraorticdeclamping.Largemulticenterevidenceisneededtovalidatethese findingsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
