Consensus Statement for reporting on the systemic inflammatory response

Investigators:

¹ R. Clive Landis, ² John M. Murkin, ³ David A. Stump, ⁴ Robert A. Baker, ⁵ Joseph E. Arrowsmith, ⁶ Filip de Somer, ² Steven L Dain, ² Wojciech B. Dobkowski, ⁷ John E. Ellis, ⁵ Florian Falter, ⁸ Gregory Fisher, ³ John W. Hammon, ⁹ Richard A. Jonas, ¹⁰ Robert S. Kramer, ¹¹ Donald S. Likosky, ¹² F. Paget Milsom, ¹³ Michael Poullis, ¹⁴ Edward D. Verrier, ¹⁵ Keith Walley, ¹⁶ Stephen Westaby

1 Chronic Disease Research Centre, Tropical Medicine Research Institute, UWI, Barbados
2 Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre‐University Campus, London, Ontario, Canada
3 Department of Anesthesiology and CT Surgery, Wake Forest University School of Medicine, Winston‐Salem, NC, USA
4 Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, South Australia
5 Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
6 Heart Center, University Hospital Gent, Gent, Belgium
7 Anesthesia & Critical Care Department, University of Pennsylvania, Philadelphia PA, USA
8 Anesthesiology & Cardiothoracic Surgery, Mount Sinai Medical Center , New York, NY, USA
9 Children's National Heart Institute, Children's National Medical Center, Washington, DC, USA
10 Cardiothoracic Surgery Department, Maine Medical Centre, Portland ME, USA
11 The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, NH, USA
12 Cardiothoracic Surgical Unit, Auckland City Hospital, Grafton, Auckland, New Zealand
13 Liverpool Heart and Chest Hospital, Liverpool, UK
14 Division of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA
15 Heart + Lung Institute, University of British Columbia, Canada
16 Cardiac Surgery Department, John Radcliffe Hospital, Oxford, UK

Funding:

E‐media Medical Educationals Inc., London, Ontario US $ 12,850; Pfizer Educational Grant: US $ 5,000

Start Date:

May 2009

End Date:

March 2010

Rationale:

Complementing the inflammatory work in chronic disease patients is the work carried out in heart surgery patients receiving cardiopulmonary bypass (CPB). These patients are prone to systemic intravascular haemolysis and an acute systemic inflammatory response to bypass. Prof. Landis has a longstanding interest in defining the molecular mechanisms of the systemic inflammatory response and has led international efforts to evaluate the evidence base of antiinflammatory interventions. One of the problems in assessing the evidence base is the lack of consensus on which inflammatory markers and clinical outcomes should be reported. The 2010 Outcomes Consensus Statement was authored by leading inflammation experts in the field, including Stephen Westaby who described the condition in 1993, attending the Outcomes heart

Methods:

The consensus panel was tasked with the second step of a process begun at the previous year’s Outcomes conference, also held in Barbados. The panel considered the list of proposed inflammatory markers and clinical outcomes from the previous consensus panel and consolidated these into three recommendations ‐ linked to three tables ‐ for investigators to report on the systemic inflammatory response.

Main Results:

The recommendations state the following: 1) measure at least one inflammatory marker, using a broad definition of the term, 2) measure at least one clinical end‐point, drawing from a list of practical yet clinically meaningful endpoints suggested by the consensus panel, and 3) report a core set of CPB and perfusion criteria that may be linked to outcomes.

Expected Impact:

It is our collective belief that adhering to these simple consensus recommendations will help define the influence of CPB practice on the systemic inflammatory response, advance our understanding of causal inflammatory mechanisms, and standardize the reporting of research findings in the peer‐reviewed literature. The Outcomes Consensus Statement may also be used to define inclusion criteria for systematic reviews of the literature.

Next Steps / Future Plans:

To use the 2010 Outcomes criteria as inclusion criteria by the STS/SCA Perfusion Guidelines Writing Group in order to evaluate the evidence base for anti‐inflammatory interventions in cardiopulmonary bypass.