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Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump

1 Les Hôpitaux Universitaires de Strasbourg (HUS)
2 Nouvel Hôpital Civil de Strasbourg
3 FMTS - Fédération de Médecine Translationnelle de Strasbourg
4 Hôpital Privé Jacques Cartier [Massy]
5 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 CHU Clermont-Ferrand
8 CHU Amiens-Picardie
9 CTSGA - Nouvelle Clinique de Tours Saint Gatien-Alliance [Tours]
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 IThEM - U1140 - Innovations thérapeutiques en hémostase
12 Clinique de la Sauvegarde [Lyon]
13 Clinique Saint Augustin
14 Hôpital Saint-Joseph [Marseille]
15 IMM - Institut Mutualiste de Montsouris
16 Hôpital Louis Pradel [CHU - HCL]
17 UCBL - Université Claude Bernard Lyon 1
18 TIMONE - Hôpital de la Timone [CHU - APHM]
19 AMU - Aix Marseille Université
20 CHU Dijon
21 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
22 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer
23 IHU ICAN - Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière]
24 CHU Pitié-Salpêtrière [AP-HP]
25 Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
26 CHU Bordeaux [Bordeaux]
27 CIC 1425 - Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique
28 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
29 CHU Nantes - Centre hospitalier universitaire de Nantes
30 ITX - unité de recherche de l'institut du thorax UMR1087 UMR6291
31 Hôpital Pontchaillou
32 CHU Lille
33 Université de Lille
34 Clinique Pasteur [Toulouse]
Thierry Caus


Objective: To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. Design: A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Societe francaise d'anesthesie et de reanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Societe francaise de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline 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 the assessment of the quality of evidence. Methods: Six fields were defined: (1) selection of the patient pathway and its 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 analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on 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 cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 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 opinions. Finally, no recommendations were provided for 3 questions. Conclusions: Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery. (C) 2022 The Authors. Published by Elsevier Masson SAS on behalf of Societe francaise d'anesthesie et de reanimation (Sfar).

Dates et versions

hal-03692568 , version 1 (09-06-2022)



Paul-Michel Mertes, Michel Kindo, Julien Amour, Christophe Baufreton, Lionel Camilleri, et al.. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. ANAESTHESIA CRITICAL CARE & PAIN MEDICINE, 2022, 41 (3), ⟨10.1016/j.accpm.2022.101059⟩. ⟨hal-03692568⟩
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