Effect of active warming on perioperative cardiovascular outcomes: a systematic review and meta-analysis of randomized controlled trials

PURPOSE: The objective of this study was to provide an updated review on the active warming effects on major adverse cardiac events, 30-day all-cause mortality, and myocardial injury after noncardiac surgery. METHOD: We systematically searched MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Web of Science, and Chinese BioMedical Literature Database. We included randomized controlled trials of adult population undergoing noncardiac surgeries that concentrate on the comparison of active warming methods and passive thermal management. Cochrane Collaboration’s tool was applied for risk-of-bias assessment. We used trial sequential analysis to evaluate the possibility of false positive or negative results. RESULTS: A total of 13,316 unique records were identified, of which only 19 with reported perioperative cardiovascular outcomes were included in the systematic review and nine of them were included in final meta-analysis. No statistically significant difference between active warming methods and routine care was found in major adverse cardiac events (RR 0.56, 95% confidence interval (CI) 0.14–2.21, I(2) = 71%, number of events 59 vs. 70), 30-day all-cause mortality (RR 0.81, 95% CI 0.43–1.54, I(2) = 0%, number of events 17 vs. 21), and myocardial injury after noncardiac surgery (RR 0.61, 95% CI 0.17–2.22, I(2) = 79%, number of events 236 vs. 234). Trial sequential analysis suggests that current trials did not reach the minimum information size regarding the major cardiovascular events. CONCLUSIONS: Compared to routine perioperative care, we found that active warming methods are not necessary for cardiovascular prevention in patients undergoing noncardiac surgery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00540-023-03205-4.