The Cochrane database of systematic reviewsMar 20, 2024

Preventive steroid use during heart-lung machine surgery in adults

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 2, 2026

Abstract

This review includes 72 trials with 17,282 participants assessing the effects of corticosteroids in cardiac surgery.

Corticosteroids may result in little to no difference in all-cause mortality, with a risk ratio of 0.90 (low-certainty evidence).
There may be an increased risk of myocardial complications associated with corticosteroid use, with a risk ratio of 1.16 (low-certainty evidence).
Corticosteroids may reduce the risk of pulmonary complications, with a risk ratio of 0.88 (low-certainty evidence).
There may be a reduction in infectious complications with corticosteroids, indicated by a risk ratio of 0.84 (low-certainty evidence).
The evidence regarding the effect of corticosteroids on gastrointestinal bleeding and renal failure is very uncertain, with risk ratios of 1.21 and 0.84, respectively.
Corticosteroids may decrease hospital stay duration, but the evidence is very uncertain, suggesting a reduction of about 0.5 days.

Simplified

BACKGROUND: Cardiac surgery triggers a strong inflammatory reaction, which carries significant clinical consequences. Corticosteroids have been suggested as a potential perioperative strategy to reduce inflammation and help prevent postoperative complications. However, the safety and effectiveness of perioperative corticosteroid use in adult cardiac surgery is uncertain. This is an update of the 2011 review with 18 studies added.

OBJECTIVES: Primary objective: to estimate the effects of prophylactic corticosteroid use in adults undergoing cardiac surgery with cardiopulmonary bypass on the: - co-primary endpoints of mortality, myocardial complications, and pulmonary complications; and - secondary outcomes including atrial fibrillation, infection, organ injury, known complications of steroid therapy, prolonged mechanical ventilation, prolonged postoperative stay, and cost-effectiveness.

SECONDARY OBJECTIVE: to explore the role of characteristics of the study cohort and specific features of the intervention in determining the treatment effects via a series of prespecified subgroup analyses.

SEARCH METHODS: We used standard, extensive Cochrane search methods to identify randomised studies assessing the effect of corticosteroids in adult cardiac surgery. The latest searches were performed on 14 October 2022.

SELECTION CRITERIA: We included randomised controlled trials in adults (over 18 years, either with a diagnosis of coronary artery disease or cardiac valve disease, or who were candidates for cardiac surgery with the use of cardiopulmonary bypass), comparing corticosteroids with no treatments. There were no restrictions with respect to length of the follow-up period. All selected studies qualified for pooling of results for one or more endpoints.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were all-cause mortality, and cardiac and pulmonary complications. Secondary outcomes were infectious complications, gastrointestinal bleeding, occurrence of new post-surgery atrial fibrillation, re-thoracotomy for bleeding, neurological complications, renal failure, inotropic support, postoperative bleeding, mechanical ventilation time, length of stays in the intensive care unit (ICU) and hospital, patient quality of life, and cost-effectiveness. We used GRADE to assess the certainty of evidence for each outcome.

MAIN RESULTS: This updated review includes 72 randomised trials with 17,282 participants (all 72 trials with 16,962 participants were included in data synthesis). Four trials (6%) were considered at low risk of bias in all the domains. The median age of participants included in the studies was 62.9 years. Study populations consisted mainly (89%) of low-risk, first-time coronary artery bypass grafting (CABG) or valve surgery. The use of perioperative corticosteroids may result in little to no difference in all-cause mortality (risk with corticosteroids: 25 to 36 per 1000 versus 33 per 1000 with placebo or no treatment; risk ratio (RR) 0.90, 95% confidence interval (CI) 0.75 to 1.07; 25 studies, 14,940 participants; low-certainty evidence). Corticosteroids may increase the risk of myocardial complications (68 to 86 per 1000) compared with placebo or no treatment (66 per 1000; RR 1.16, 95% CI 1.04 to 1.31; 25 studies, 14,766 participants; low-certainty evidence), and may reduce the risk of pulmonary complications (risk with corticosteroids: 61 to 77 per 1000 versus 78 per 1000 with placebo/no treatment; RR 0.88, 0.78 to 0.99; 18 studies, 13,549 participants; low-certainty evidence). Analyses of secondary endpoints showed that corticosteroids may reduce the incidence of infectious complications (risk with corticosteroids: 94 to 113 per 1000 versus 123 per 1000 with placebo/no treatment; RR 0.84, 95% CI 0.76 to 0.92; 28 studies, 14,771 participants; low-certainty evidence). Corticosteroids may result in little to no difference in incidence of gastrointestinal bleeding (risk with corticosteroids: 9 to 17 per 1000 versus 10 per 1000 with placebo/no treatment; RR 1.21, 95% CI 0.87 to 1.67; 6 studies, 12,533 participants; low-certainty evidence) and renal failure (risk with corticosteroids: 23 to 35 per 1000 versus 34 per 1000 with placebo/no treatment; RR 0.84, 95% CI 0.69 to 1.02; 13 studies, 12,799; low-certainty evidence). Corticosteroids may reduce the length of hospital stay, but the evidence is very uncertain (-0.5 days, 0.97 to 0.04 fewer days of length of hospital stay compared with placebo/no treatment; 25 studies, 1841 participants; very low-certainty evidence). The results from the two largest trials included in the review possibly skew the overall findings from the meta-analysis.

AUTHORS' CONCLUSIONS: A systematic review of trials evaluating the organ protective effects of corticosteroids in cardiac surgery demonstrated little or no treatment effect on mortality, gastrointestinal bleeding, and renal failure. There were opposing treatment effects on cardiac and pulmonary complications, with evidence that corticosteroids may increase cardiac complications but reduce pulmonary complications; however, the level of certainty for these estimates was low. There were minor benefits from corticosteroid therapy for infectious complications, but the evidence on hospital length of stay was very uncertain. The inconsistent treatment effects across different outcomes and the limited data on high-risk groups reduced the applicability of the findings. Further research should explore the role of these drugs in specific, vulnerable cohorts.

Funding

Competing interests

RGA: has declared that he has no conflict of interest. RGA was a content editor for Cochrane Heart but had no role in the editorial process for this review. Although working as a health professional as a Clinical Research Fellow in Cardiothoracic Surgery and as a cardiac surgeon for Imperial College Healthcare NHS Trust, he does not benefit from the positions expressed in this review. GO: has declared that he has no conflict of interest. Despite working as a cardiothoracic surgeon at ASST G.O.M. Niguarda Hospital, he does not benefit from the positions expressed in this review. RC: has declared that she has no conflict of interest. Despite working as a cardiothoracic surgeon with a National Training Number (NTN), she does not benefit from the positions expressed in this review. FG: has declared that she has no conflict of interest. Despite working as a cardiothoracic surgeon NTN, she does not benefit from the positions expressed in this review. NT: has declared that he has no conflict of interest. He currently holds an NTN in Cardiothoracic Surgery, and is a Higher Speciality Trainee at Health Education East Midlands. Despite working as a Cardiothoracic Surgery Registrar at Glenfield Hospital, he does not benefit from the positions expressed in this review. KE: has declared that she has no conflict of interest. Despite working as a health professional, she does not benefit from the positions expressed in this review. DF: has declared that he has no conflict of interest. Daniel Fudulu has published several papers on the use of prophylactic corticosteroids in paediatric heart surgery whilst employed at the University of Bristol. Despite working as a Clinical Lecturer in cardiac surgery at Bristol Royal Infirmary, he does not benefit from the positions expressed in this review. RM: has declared that he has no conflict of interest. Despite working as a health professional, he does not benefit from the positions expressed in this review. MK: has declared that he has no conflict of interest. Despite working as a consultant of cardiothoracic and vascular surgery at the Deutsches Herzzentrum der Charité in Berlin, he does not benefit from the positions expressed in this review. GE: has declared that he has no conflict of interest. Despite working as a health professional, he does not benefit from the positions expressed in this review. FL: has declared that she has no conflict of interest. ML: declares that he has received personal payments for expert testimony, consulting fees, honoraria for lectures/presentations from Baxter, 3M, Nordic and Medtronic, unrelated to the current work. Despite working as a health professional, he does not benefit from the positions expressed in this review. SK: has declared that he has no conflict of interest. Despite working as a consultant cardiothoracic surgeon at South Tees Hospital, he does not benefit from the positions expressed in this review. MZ: has declared that he has no conflict of interest. Despite working as a health professional, he does not benefit from the positions expressed in this review. GJM: undertakes unpaid work as a grant committee member for the British Heart Foundation. He also receives a grant for the British Heart Foundation that is paid to the University of Leicester and his salary was part funded by this grant until 2022. GJM also declares a grant from NIHR (health technology assessment grant, programme development grants), which is paid to his institution, though he can direct these resources to fund research in line with the grant specifications. Despite working as a cardiac surgeon, University Hospitals, Leicester, he does not benefit from the positions expressed in this review.

PubMed

Preventive steroid use during heart-lung machine surgery in adults

Abstract

Funding

Competing interests

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the circadian biology brief

Abstract

Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the circadian biology brief