Perioperative Care in Cardiac Surgery
Recommendations
Tranexamic acid or epsilon aminocaproic acid during on-pump cardiac surgical procedures
(I, A)Perioperative glycemic control
(I, B-R)A care bundle of evidence-based best practices to reduce surgical site infections
(I, B-R)Goal-directed fluid therapy
(I, B-R)A perioperative, multimodal, opioid-sparing, pain management plan
(I, B-NR)Avoidance of persistent hypothermia (<36.0°C) after cardiopulmonary bypass in the early postoperative period
(I, B-NR)Maintenance of chest tube patency to prevent retained blood
(I, B-NR)Postoperative systematic delirium screening tool use at least once per nursing shift
(I, B-NR)Stopping smoking and hazardous alcohol consumption 4 weeks before elective surgery
(I, C-LD)Early detection of kidney stress and interventions to avoid acute kidney injury after surgery
(IIa, B-R)Use of rigid sternal fixation to potentially improve or accelerate sternal healing and reduce mediastinal wound complications
(IIa, B-R)Prehabilitation for patients undergoing elective surgery with multiple comorbidities or significant deconditioning
(IIa, B-NR)An insulin infusion to treat hyperglycemia in all patients postoperatively
(IIa, B-NR)Strategies to ensure extubation within 6 h of surgery
(IIa, B-NR)Patient engagement tools, including online/applicationbased systems to promote education, compliance, and patient-reported outcomes
(IIa, C-LD)Chemical or mechanical thromboprophylaxis after surgery
(IIa, C-LD)Preoperative measurement of hemoglobin A1c to assist with risk stratification
(IIa, C-LD)Preoperative correction of nutritional deficiency when feasible
(IIa, C-LD)Continued consumption of clear liquids up until 2 to 4 h before general anesthesia
(IIb, C-LD)Preoperative oral carbohydrate loading may be considered before surgery
(IIb, C-LD)Stripping or breaking the sterile field of chest tubes to remove clots
(III - No Benefit, A)Hyperthermia (>37.9°C) while rewarming on cardiopulmonary bypass.
(III - Harm, B-R)Recommendation Grading
Overview
Title
Perioperative Care in Cardiac Surgery - Enhanced Recovery After Surgery Society Recommendations
Authoring Organization
Enhanced Recovery After Cardiac Surgery Society
Publication Month/Year
May 1, 2019
Last Updated Month/Year
January 30, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D011300 - Preoperative Care, D000074022 - Anesthesia, Cardiac Procedures
Keywords
cardiac surgery, postoperative, Preoperative Care, intraoperative, serum albumin, Hypoalbuminemia, Hyperthemia