Aggressive warming during surgery does not reduce major complications
Maintaining higher body temperature shows no significant benefit

Date:
April 4, 2022
Source:
American College of Cardiology
Summary:
Patients kept at a body temperature of 37 C during major surgery
had no fewer cardiac complications than patients kept at 35.5 C,
according to new data. There were also no differences in the number
of infections or required blood transfusions in patients kept at
cooler body temperatures.



FULL STORY ========================================================================== Patients kept at a body temperature of 37 C during major surgery had
no fewer cardiac complications than patients kept at 35.5 C, according
to data presented at the American College of Cardiology's 71st Annual Scientific Session. There were also no differences in the number of
infections or required blood transfusions in patients kept at cooler
body temperatures.


==========================================================================
Body temperature generally decreases during surgery, largely because
anesthetic medications interfere with the body's processes for regulating temperature.

While practices vary around the world, nursing staff in Western countries typically use forced-air heaters to keep patients warm during surgery,
with a target temperature of 36 C, or 96.8 F. This trial, one of the
largest to date, sought to determine whether warming patients even more --
to 37 C, or 98.6 F - - would reduce the risk of cardiac complications,
which are a leading cause of death in the first 30 days after major
surgery.

Results showed no significant differences between groups for the trial's primary endpoint, a composite of troponin elevation due to ischemia
(an indicator of heart injury), non-fatal cardiac arrest or death from
any cause within 30 days after surgery. Researchers also reported no differences for any of the trial's secondary endpoints.

"This trial tells us that there is no benefit to aggressively warming
patients to 37 C during surgery. It is simply unnecessary, and it
doesn't improve any substantive outcomes," said Daniel I. Sessler, MD,
Michael Cudahy professor and chair of the Department of Outcomes Research
at Cleveland Clinic and the trial's lead author. "Also, the results
show that 36 C should not be considered the threshold for defining
mild hypothermia since there was no harm at 35.5 C." The researchers
enrolled 5,050 patients who had surgery at 13 medical centers, mostly in
China. Participants had various major noncardiac surgical procedures, with
a minimum duration of two hours and an average duration of four hours.

Half of the patients were randomly assigned to receive routine care,
with a target body temperature of 35.5 C, while half received aggressive warming, with a target body temperature of 37 C.

For patients assigned to routine care, nursing staff put a warming
cover in position but did not activate it until the patient's body
temperature decreased to less than 35.5 C, resulting in an average group
body temperature of 35.6 C.

With the more aggressive warming protocol, nurses covered patients with a heated blanket for 30 minutes before surgery and then used two forced-air heaters to keep patients warmed to a mean of 37.1 C during surgery.

In addition to seeing no benefit in terms of the composite primary
endpoint, the trial reported no significant differences between groups
in terms of serious wound infections, length of hospitalization, hospital re-admissions or the need for blood transfusions. The investigators were surprised that rates of wound infections and transfusions were similar to previous studies, which suggested that both were more common in patients maintained at lower body temperatures.

Nearly all patients were enrolled in China, Sessler said, but the results should be generalizable to patients and health care settings in other countries.

"This study shows that it is reasonable to keep patients warm, but we saw
no evidence whatsoever that it makes a difference if they're just above
or just below 36 C," Sessler said. "Surgical patients should still be
warmed, but there's no need to be super-aggressive about the warming."
The study did not assess less serious or non-medical outcomes, such as
patient comfort or shivering. Sessler said that patients maintained at
a lower body temperature may shiver or feel cold after surgery, but both
are temporary and unlikely to have a meaningful health impact.

This study was simultaneously published online in The Lancetat the time
of presentation. The study was partially funded by 3M.


========================================================================== Story Source: Materials provided by American_College_of_Cardiology. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Daniel I Sessler, Lijian Pei, Kai Li, Shusen Cui, Matthew T V Chan,
Yuguang Huang, Jingxiang Wu, Xuemei He, Gausan R Bajracharya, Eva
Rivas, Carmen K M Lam, Kai Li, Shusen Cui, Yaozhong Zhang, Hai Sun,
Zhouting Hu, Wangyu Li, Yangdong Han, Wei Han, Pengcheng Zhao, Hong
Ye, Peng Chen, Zhihua Zhu, Weisong Dai, Lei Jin, Wenchao Bian, Yan
Liu, Matthew T V Chan, Beaker B Y Fung, Eva Lee, Ka Yan Hui, Gordon
Y S Choi, Wai Tat Wong, Chee Sam Chan, Lijian Pei, Yuguang Huang,
Yi Xiao, Bin Wu, Weiming Kang, Ling Lan, Chen Sun, Jingxiang Wu,
Yuwei Qiu, Wei Tang, Yunyun Zhang, Qi Huang, Xiaofei Lu, Tingting
Li, Qimeng Yu, Jie Yu, Xuemei He, Rurong Wang, Hong Chang, Yunxia
Zuo, Zhirong Sun, Wenting Hou, Congxia Pan, Xi Liu, Xue Zhang,
Sheng Wang, Yin Kang, Zhengliang Ma, Xiaoping Gu, Changhong Miao,
Daniel I Sessler, Eva Rivas, Gausan R Bajracharya, Mauro Bravo,
Andrea Kurz, Alparslan Turan, Kurt Ruetzler, Kamal Maheshwari,
Guangmei Mao, Yanyan Han, Ece Yamak Altinpulluk, Mateo Montalvo
Compana, Federico Almonacid-Cardenas, Steve M Leung, CeCelia K
Hanline, David M Chelnick, Marianne Tanios, Michael Walters, Michael
J Rosen, Stephanie Ezoke, Edward J Mascha, Carmen K M Lam, Benny
C P Cheng, Renee P L Yip, P J Devereaux. Aggressive intraoperative
warming versus routine thermal management during non-cardiac surgery
(PROTECT): a multicentre, parallel group, superiority trial. The
Lancet, 2022; DOI: 10.1016/S0140-6736 (22)00560-8 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220404105708.htm

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