Introduction

Welcome to Best Evidence in Cardiac Surgery. This is a database for the busy Cardiac Surgeon who has many clinical questions in his or her everyday practise but does not have the time to spend hours looking up the evidence on each topic.

Why Best BETS ?

If you have a clinical question where do you look ? Do you do a full search on the internet, request all the papers and review all the papers yourself ? Or does your hectic clinical workload prevent this? So do you go and consult a trusted textbook that you have used for many years? But is it out of date, what does it say on Off-pump surgery or MIDCABs?

BETs were developed in the Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is.

Origins of Best BETS

Best BETs were invented in the Emergency Department of our hospital by Prof. Kevin Mackway-Jones and in 5 years has grown into an invaluable resource of over 500 topics in Emergency Medicine.

We have joined forces with our collegues at www.bestbets.org to start providing best evidence topics in Cardiac Surgery, so feel free to see if your questions are answered by our BETS. If you don’t see a question that you want answered E-mail us with it . Or even better do the BET yourself and we will include it on this website too !!

Please note that our Cardiac BETs Journal Club started producing Best Evidence topics on the 11th of October 2002. We project that in our first year we will have 100 topics, but while we are still in our infancy, please bear with us and come back soon if you don’t find what you are looking for…or even better why not get yourself a web publication and join us and do a topic yourself !!

The Database

Cardiology
Buccal suscard in left ventricular failure
Thrombolysis may be of benefit in patients with prolonged cardiac arrest
Biphasic Waveform Defibrillation for Adult Ventricular Fibrillation
Which antidysrhythmic is best in acute onset atrial fibrillation
Troponin T does not rule out myocardial damage until 12 hours after the onset of chest pain
NIPPV for acute cardiogenic pulmonary oedema
Oral or intravenous beta-blockers in acute myocardial infarction
Nitrates as first line treatment for acute left ventricular failure
The sensitivity of a normal chest Xray in ruling out aortic dissection
General Cardiac Surgery
Is amiodarone or digoxin better in AF post cardiac surgery in terms of time to return of sinus rhythm?
Is rate control superior to conversion strategy in AF post cardiac surgery?
Is a pleural drain of value after CABG with LIMA in preventing Pleural Effusions when the Pleura is opened?
High versus low dose aspirin post CABG
Prophylactic Amiodarone in the prevention of Atrial Fibrillation
Is Sotalol effective in Atrial Fibrillation after cardiac surgery?
Topical Vancomycin after Cardiac Surgery
Does Aspirin 6 hours after CABG optimise graft patency?
Which patients would benefit from an Intra-aortic Balloon Pump prior to Cardiac Surgery ?
Does liberal use of Bone Wax increase the risk of Mediastinitis
Misc.
How good is clinical examination at detecting a significant patent ductus arteriosus in the preterm neonate?
Perfusion & Anaesthesia
Low dose (renal dose) dopamine in the critically ill patient
Bypass is better than external rewarming after hypothermic cardiac arrest
Is central venous pressure as reliable when the central line is in the femoral vein?
Does a central line inserted into the femoral vein have a higer complication rate than jugular or subclavian routes
Is prophylactic Haemofiltration during Cardiopulmonary Bypass of Benefit during Cardiac Surgery ?
Is the CVP reading equally reliable if the central line is inserted via the Femoral Vein
The Infective Complications of a Femoral Central Venous Line
Perfusion & Anaethesia
USS guidance reduces the complications of central line placement.
Thrombotic complications of a Femoral Central Venous Catheter
Thoracic Surgery
Are Seldinger Technique Chest Drains Associated With Fewer Complications
Normal PaO2 on air and normal clinical examination to rule out traumatic pneumothorax
Prophylactic antibiotics in patients with isolated chest trauma requiring closed tube thoracostomy
Admission not needed for uncomplicated sternal fractures
Needle aspiration better than chest drain for spontaneous pneumothorax

Checklists

The checklists listed below are the method by which we assess each paper in our journal club. They provide a reproducible way to assess papers in an evidence based fashion, and also highlight weaknesses in papers that you may otherwise miss in a single read. It is our intention to fill in one of these checklists for every paper we assess and provide them on the Bestbets website for those clinicians who require more information on how we came to the decisions made in the assessment of the papers.

Contact us and submit a question or a full Cardiac BET

Do you have a clinical question that you think would made a good topic for a BET. Before you send us a question, have a look at the way we format our BETs. Then submit a 3 part question to us, including your details as the potential author. You will then have 1 year to complete the BET and once complete you will appear as the author of this topic on the www.bestbets.org website. If it is good enough you may also get it published in one of our paper journals that publish BETS too !! So give it a go and submit a cardiac BET to us.


	Best Evidence In Cardiac Surgery from The Manchester Royal Infirmary