Article description

Summary:

• To examine compliance with, and the effect of, introducing an enhanced recovery after cardiac surgery (ERCS) protocol on outcome.
• Study design was a retrospective, historical controlled, observational study so vulnerable to selection and treatment bias.
• Historical control group management was not described.
• ERACS group:
  • Prehabilitation and oral acetaminophen 1g and some, gabapentin 300 mg administered preoperatively.
  • Intraoperatively, IV infusions of ketamine, dexmedetomidine, fentanyl, desmopressin and aminocaproic acid were administered.
  • Transversus thoracis or pectointercostal fascial plane analgesic regional blocks were performed, neuromuscular blockade was reversed and ondansetron administered, at the end of surgery.
  • Acute normovolaemic haemodilution and thromboelastography guided blood management were undertaken.
• Study population sample size was 106: control 52 and ERACS 54.
• 44% attrition in ERACS group because of inadequate compliance with protocol.
• Good compliance was achieved with all but two of the protocol interventions
• No statistically significant differences between groups in the durations of tracheal intubation, intensive care unit and hospital stays or incidences of delirium and atrial fibrillation. The incidence of nausea and vomiting was significantly reduced in the ERACS, compared to control group.

Conclusions:

• Compliance with a ERACS protocol achieved in a selected group.
• Results provide no evidence to support effect of ERACS protocol on outcomes except nausea and vomiting.