Filmed at the 2019 AATS Annual Meeting in Toronto, Canada, Daniel Engelman of Baystate Medical Center in Springfield, Massachusetts, USA, moderates a discussion on enhanced recovery after surgery (ERAS) for cardiac surgery guidelines for perioperative care. Dr Engelman, who is also the President of the ERAS Cardiac Society, is joined by Louis Perrault of the Montreal Heart Institute in Quebec, Canada, Marc Gerdisch of Franciscan St. Francis Heart Center in Indianapolis, Indiana, USA, Michael Grant of the Johns Hopkins Hospital in Baltimore, Maryland, USA, and Judson Williams of Duke University Medical Center in Raleigh, NC, USA. The panelists highlight some of the recommendations from the first cardiac ERAS guidelines(1). They talk of the importance of prehabilitation and new preoperative nutritional recommendations, as well as intraoperative guidelines for multimodal analgesia, chest closure, and chest tube drainage. They note that many aspects of perioperative care are addressed in the guideline and note the recommendations on preventing venous thromboembolism and early extubation. Throughout the discussion, the group emphasizes the multidisciplinary nature of the ERAS effort.
Reference
Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations [published online ahead of print May 4, 2019.]. JAMA Surg. doi: 10.1001/jamasurg.2019.1153.
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An example of how products and companies have creeped into our cardiac surgery guidelines.
The ERAS recommendations for chest tube patency do not mention about the use of suction ( most commonly -20cmH2O) applied to the drainage chambers connected to the chest tubes after shifting the patient to ICU. This is the most commonly utilised procedure used to prevent tamponade. It works very well and is used in almost all major cardiac centers. I would like to ask the authors, why no mention is made of such an important step to maintain chest tube patency. Instead they have stressed on Active chest tube clearance ( apparently a product) and all the references are about that product in the name of active chest tube clearance. There are two authors who are on the board of the company making the product. I feel that mention of the use of suction should be included in the chest tube patency section which is used worldwide and help to prevent cardiac tamponade. I would appreciate the views of other senior colleagues. These are guidelines used worldwide and I am disappointed to see the omission of this important step and promotion of a product in the name of active chest tube clearance in all the references cited.
The current and future generations of cardiac surgeons will forget about the importance of suction applied post operatively if they follow these guidelines which has no mention of his important step and is promoting a product.
I appeal to all the senior collegaues to share their views.