Intraoperative High-Dose Dexamethasone for Cardiac Surgery:A Randomized Controlled Trial

Jan M. Dieleman, MD; Arno P. Nierich, MD; Peter M. Rosseel, MD; Joost M. van der Maaten, MD; Jan Hofland, MD; Jan C. Diephuis, MD; Ronald M. Schepp, MD; Christa Boer, PhD; Karel G. Moons, PhD; Lex A. van Herwerden, MD; Jan G. Tijssen, MD; Sandra C. Numan, MSc; Cor J. Kalkman, MD; Diederik van Dijk, MD; for the Dexamethasone for Cardiac Surgery (DECS) Study Group

JAMA. 2012;308(17):1761-1767. doi:10.1001/jama.2012.14144.

ABSTRACT

Context  Prophylactic corticosteroids are often administered during cardiac surgery to attenuate the inflammatory response to cardiopulmonary bypass and surgical trauma; however, evidence that routine corticosteroid use can prevent major adverse events is lacking.

Objective  To quantify the effect of intraoperative high-dose dexamethasone on the incidence of major adverse events in patients undergoing cardiac surgery.

Design, Setting, and Participants  A multicenter, randomized, double-blind, placebo-controlled trial of 4494 patients aged 18 years or older undergoing cardiac surgery with cardiopulmonary bypass at 8 cardiac surgical centers in the Netherlands enrolled between April 13, 2006, and November 23, 2011.

Intervention  Patients were randomly assigned to receive a single intraoperative dose of 1 mg/kg dexamethasone (n = 2239) or placebo (n = 2255).

Main Outcome Measures  A composite of death, myocardial infarction, stroke, renal failure, or respiratory failure, within 30 days of randomization.

Results  Of the 4494 patients who underwent randomization, 4482 (99.7%) could be evaluated for the primary outcome. A total of 157 patients (7.0%) in the dexamethasone group and 191 patients (8.5%) in the placebo group reached the primary study end point (relative risk, 0.83; 95% CI, 0.67-1.01; absolute risk reduction, −1.5%; 95% CI, −3.0% to 0.1%; P = .07). Dexamethasone was associated with reductions in postoperative infection, duration of postoperative mechanical ventilation, and lengths of intensive care unit and hospital stays. In contrast, dexamethasone was associated with higher postoperative glucose levels.

Conclusion  In our trial of adults undergoing cardiac surgery, the use of intraoperative dexamethasone did not reduce the 30-day incidence of major adverse events compared with placebo.