Phosphocreatine in cardiac surgery patients: a meta-analysis of randomized controlled trials

Objective There is experimental evidence that phosphocreatine (PCr) can decrease ischemia/reperfusion injury of the heart. The authors investigated if PCr would improve heart performance as compared with standard treatment in cardiac surgery. Design Meta-analysis of randomized controlled trials. Setting Hospitals. Participants Adult and pediatric patients undergoing cardiac surgery. Interventions The ability of PCr to improve cardiac outcomes as compared with standard treatment was investigated. Measurements and main results PubMed/Medline, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, WANGFANG DATA, and VIP Paper Check System were searched up to 1 March 2017. We included 26 randomized controlled trials comprising 1,948 patients. Random and fixed effects models were used to estimate odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI). Phosphocreatine use was associated with a reduced rate of intraoperative inotropic support (27% vs. 44%; OR 0.47, 95% CI 0.35-0.61; P P P Conclusions In randomized trials, PCr administration was associated with a reduced rate of intraoperative inotropic support, major arrhythmias, and increased spontaneous recovery of the cardiac rhythm after aortic declamping. Large multicenter evidence is needed to validate these findings.