Aggressive warming during non-cardiac surgery does not improve outcomes

Findings from the PROTECT trial showed that there was no evidence of significant perioperative outcome changes in patients randomised to intraoperative temperatures of 35.5°C (very mild hypothermia) when compared with 37°C (normothermia) for non-cardiac surgery.

Prof. Daniel Sessler (Cleveland Clinic, OH, USA) presented the multicentre, parallel-group, PROTECT (NCT03111875) trial results, which were simultaneously published in The Lancet [1,2]. The rationale behind the study was that intraoperative hypothermia can contribute to blood loss, infection, and myocardial injury, and the researchers asked whether aggressive intraoperative warming was superior to normothermia in mitigating perioperative complications.

A total of 5,013 participants were randomised to receive either aggressive warming to a target core temperature of 37°C (aggressively warmed arm; n=2,507) or routine thermal management to a target of 35.5°C (routine thermal management arm; n=2,506) during non-cardiac surgery. The primary endpoint of PROTECT was a composite of myocardial injury (troponin elevation, apparently of ischaemic origin), non-fatal cardiac arrest, and all-cause mortality within 30 days of surgery, as assessed in the modified intention-to-treat population.

The results showed that at least 1 of the primary outcome components occurred in 9.9% of participants in the aggressively warmed group and 9.6% in the routine thermal management arm (relative risk 1.04; 95% CI 0.87–1.24; P=0.69). With regard to safety, no significant differences were measured between the arms.

Prof. Sessler concluded that aggressive warming management was not superior to routine thermal management for non-cardiac surgeries.

1. 
   
   1. Sessler DI, et al. Very Mild Perioperative Hypothermia Versus Aggressive Warming And Myocardial Injury After Non-cardiac Surgery: The PROTECT Trial. Abstract 409–08, ACC 2022, 2–4 April, Washington DC, USA.
   2. Sessler DI, et al. Lancet 2022; 399(10337):1799-1180.

 

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Posted on 15 June 202224 June 2022