Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature highlights practice-changing clinical trials and high-impact mechanistic and perfusion research. A pragmatic multicenter RCT in JAMA supports using prothrombin complex concentrate instead of frozen plasma for coagulopathic bleeding in cardiac surgery, with improved hemostasis and less AKI. A Neuron mechanistic study identifies Piezo2-mediated sensing of microvascular motion in injured dorsal root ganglia as a trigger for spontaneous neuropathic pain, opening
Summary
This week’s anesthesiology literature highlights practice-changing clinical trials and high-impact mechanistic and perfusion research. A pragmatic multicenter RCT in JAMA supports using prothrombin complex concentrate instead of frozen plasma for coagulopathic bleeding in cardiac surgery, with improved hemostasis and less AKI. A Neuron mechanistic study identifies Piezo2-mediated sensing of microvascular motion in injured dorsal root ganglia as a trigger for spontaneous neuropathic pain, opening new therapeutic targets. A contemporary RCT-based meta-analysis shows minimally invasive extracorporeal circulation (MiECC) reduces mortality and major complications versus conventional CPB, supporting diffusion of perfusion innovations.
Selected Articles
1. Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial.
A pragmatic multicenter randomized trial (n≈528 analyzed) found 4-factor PCC superior to frozen plasma for hemostatic effectiveness in coagulopathic bleeding during cardiac surgery (77.9% vs 60.4%), with fewer allogeneic transfusions and lower rates of serious adverse events including postoperative AKI through day 30.
Impact: Provides Level I evidence that directly informs transfusion algorithms in cardiac surgery by demonstrating superiority of PCC over standard frozen plasma in stopping coagulopathic bleeding and reducing transfusion-related complications.
Clinical Implications: Consider adopting PCC-first protocols for factor replacement in cardiac surgery bleeding to improve hemostasis, reduce allogeneic transfusions, and lower AKI risk; update perioperative blood-management pathways and training accordingly.
Key Findings
- Hemostatic effectiveness higher with PCC vs FFP (77.9% vs 60.4%; difference 17.6%).
- PCC reduced allogeneic transfusion requirements (mean units lower) and lowered serious adverse events including AKI through day 30.
2. Vascular motion in the dorsal root ganglion sensed by Piezo2 in sensory neurons triggers episodic pain.
Preclinical work shows that dynamic microvascular movements within injured dorsal root ganglia trigger episodic spontaneous neuropathic pain via Piezo2 mechanotransduction in sensory neurons; angiogenesis and pericyte changes amplify clustered neuronal firing, and anti-VEGF or Piezo2 targeting suppresses pain and clustered firing in mouse models.
Impact: Identifies a novel, actionable mechanistic link (vascular motion → Piezo2) underlying spontaneous neuropathic pain, shifting potential interventions toward vascular dynamics and Piezo2 modulation rather than neuron-only targets.
Clinical Implications: Translational potential to develop peripherally restricted Piezo2 modulators or vascular/anti-angiogenic strategies for refractory neuropathic spontaneous pain; clinical translation will require validation in human tissues and early-phase trials.
Key Findings
- Microvascular motion within injured DRG triggers spontaneous pain and clustered neuronal firing.
- Piezo2 in sensory neurons is necessary for sensing vascular motion; anti-VEGF suppressed angiogenesis-linked pain amplification.
3. Minimal invasive extracorporeal circulation versus conventional cardiopulmonary bypass in cardiac surgery: a contemporary systematic review and meta-analysis.
Meta-analysis of 36 randomized trials (n≈4,849) indicates MiECC is associated with lower mortality (OR 0.66), reduced postoperative myocardial infarction and cerebrovascular events, less transfusion and bleeding complications, and shorter ventilation, ICU, and hospital stays compared with conventional CPB.
Impact: Aggregates RCT-level data showing MiECC improves hard clinical outcomes after cardiac surgery, providing strong rationale for perfusion practice change and wider implementation where feasible.
Clinical Implications: Perfusion teams should evaluate implementing MiECC circuits and standardized protocols (anticoagulation, priming, management) as part of cardiac surgical quality improvement, with attention to local resources and training.
Key Findings
- MiECC reduced mortality vs conventional CPB (OR 0.66, I2=0%).
- MiECC lowered postoperative MI and cerebrovascular events and reduced transfusions, re-exploration for bleeding, and length of ventilation/ICU/hospital stay.