Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial

Objective.-To assess the relationship between body temperature and cardiac morbidity during the perioperative period. Design.-Randomized controlled trial comparing routine thermal care (hypothermic group) to additional supplemental warming care (normothermic group). Setting.-Operating rooms and surgical intensive care unit at an academic medical center. Subjects.-Three hundred patients undergoing abdominal, thoracic, or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease. Outcome Measure.-The relative risk of a morbid cardiac event (unstable angina/ischemia, cardiac arrest, or myocardial infarction) according to thermal treatment. Cardiac outcomes were assessed in a double-blind fashion. Results.-Mean core temperature after surgery was lower in the hypothermic group (35.4±0.1°c) than in the normothermic group (36.7±0.1 °C) (P<.001) and remained lower during the early postoperative period. Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group (1.4% vs 6.3%; P=.02). Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis (relative risk, 2.2; 95% confidence interval, 1.1-4.7; P=.04), indicating a 55% reduction in risk when normothermia was maintained. Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group (2.4% vs 7.9%; P=.04). Conclusion.-In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.