"Outcomes" Consensus Statement on the Systemic Inflammatory Response

Principal collaborators:

Clive Landis (CDRC); Joseph E. Arrowsmith, Papworth Hospital, Cambridge, UK; Robert A. Baker, Flinders Medical Centre, Adelaide, Australia; Filip de Somer, University Hospital Gent, Belgium; Wojciech B. Dobkowski, London Health Sciences Centre, Ontario, Canada; John E. Ellis, University of Pennsylvania, Philadelphia, USA; Florian Falter, Papworth Hospital, Cambridge, UK; Gregory Fisher, Mount Sinai Medical Center, New York, USA; John W. Hammon, Wake Forest University Baptist Medical Centre, NC, USA; Richard A. Jonas, Children‘s National Medical Centre, Washington DC, USA; Robert S. Kramer, Maine Medical Centre, Portland, Maine, USA; Donald S. Likosky, Dartmouth College, New Hampshire, USA; F. Paget Milsom, Auckland Medical Centre, New Zealand; John M. Murkin, London Health Sciences Centre, Ontario, Canada; Michael Poullis, Liverpool Heart and Chest Hospital, UK; David A. Stump, Wake Forest University Baptist Medical Centre, NC, USA; Edward D. Verrier, University of Washington, Seattle, USA; Keith Walley, Heart + Lung Institute, British Columbia, Canada; Stephen Westaby, Radcliffe Hospital, Oxford, UK

"Outcomes"is a long established International Symposium focusing on neurobehavioral outcomes, neuromonitoring, and cerebroprotective strategies in patients undergoing cardiac and vascular surgery (www.outcomeskeywest.com). In 2006, Prof. Landis was elected co-organiser of ―Outcomes‖ and attracted this heart surgery conference to Barbados between 2007-2009 with UWI as host institution. Several highly influential Consensus Statements and Practice Guidelines have emanated from previous ―Outcomes‖ meetings between 1995 – 2006, on such topics as ―Assessment of neurobehavioral outcomes after cardiac surgery‖, ―Defining dysfunction: group means vs. incidence analysis‖, and ―An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response‖. The 2008 and 2009 ―Outcomes‖ symposia published Consensus Statements on the Systemic Inflammatory Response authored by Prof. Landis together with an array of world leaders hailing from the US, Canada, UK, Europe, Australia, and New Zealand.

Background:

The lack of established cause and effect between putative mediators of inflammation and adverse clinical outcomes may explain why clinical advances to curb the systemic inflammatory response have proven such a disappointment.

Methods:

In order to promote a better understanding of the influence of CPB practice on the systemic inflammatory response the Outcomes Consensus Panel in 2009 set out to define minimal criteria for the conduct of trials into the systemic inflammatory response. This panel was tasked with updating, as well as simplifying, a previous consensus statement.

Results:

The Consensus Recommendations are summarized below:

1. Measure at least one inflammatory marker, using a broad definition of the term.
2. Report at least one clinical end-point, drawing from a list of practical yet clinically meaningful endpoints.
3. Report a core set of CPB and perfusion criteria that may be linked to clinical outcomes

Outcomes/Expected Outcomes:

Two Consensus Statements have arisen from this work, the original arising from the 2008 Outcomes symposium and the update discussed here from the 2009 symposium. Both were published in The Heart Surgery Forum with Prof. Landis as first author.

Impact/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.