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Omega 3 Fatty Acid Administration in Cardiac Surgery Patients

9/20/2017 10:23:02 AM
Patients undergoing cardiac surgery are at an increased risk of systemic inflammation resulting from ischemia-reperfusion and oxidative stress. When surgery is performed with cardiopulmonary bypass—a technique that temporarily functions for the heart and lungs during the procedure—inflammation is further promoted by blood contact with non-endothelial surfaces. Complications of cardiac surgery are related to the inflammatory cascade and can include atrial fibrillation or stroke. Omega-3 fatty acids have shown promise for decreasing the incidence of perioperative atrial fibrillation and may reduce the risk of other complications because of their anti-inflammatory effects.
 
Prior to this publication, several systematic reviews and meta-analyses, mostly published between 2011 and 2014, have concluded that omega-3 fatty acids are not able to improve clinical outcomes in cardiac surgery patients. As research continues to emerge in this area, an updated review and meta-analysis was published in 2017 in the journal Clinical Nutrition.   
 
The review included 19 studies and 4335 patients. All studies were randomized controlled trials of adults undergoing elective or emergency heart surgery, including coronary artery bypass graft and valve surgery. The intervention was fish oil-containing intravenous emulsions as part of parenteral nutrition or fish oil-containing oral or enteral nutrition. The primary outcome measure for the meta-analysis was intensive care unit (ICU) length of stay, with other relevant clinical outcomes as secondary outcomes.
 
Only 6 studies provided adequate data for the primary outcome measure, and aggregated results showed no association between omega-3 administration and ICU length of stay (weighted mean difference WMD=2.95; 95% CI, -10.28 to 4.39; p=.43). Analysis of secondary outcomes showed that omega-3 fatty acids significantly reduced hospital length of stay (WMD= -1.37; 95% CI, -2.41 to -0.33; p=.01) and postoperative atrial fibrillation (odds ratio = -.78; 95% CI, 0.68-0.90; p=.004).
 
This meta-analysis quantifies the most current research available on the relationship between omega-3 fatty acids and cardiac surgery. Evidence suggests that intravenous or enteral omega-3 fatty acid administration shortens hospital length of stay and reduces the incidence of postoperative atrial fibrillation. The wide range in omega-3 type, dosage, and length of administration, however, makes it impossible to recommend specific protocols at this time.
 
Reference: Langlois PL, Hardy G, Manzanares W. Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An updated systematic review and meta-analysis. Clin Nutr. 2017;36(3):737-746.