• Patrick J McCormick, Matthew A Levin, Hung-Mo Lin, Daniel I Sessler, and David L Reich.
• Departments of Anesthesiology (P.J.M., M.A.L., D.L.R.), Genetics and Genomic Sciences (M.A.L.), and Population Health Science and Policy (H.-M.L.), Icahn School of Medicine at Mount Sinai, New York, New Yo... more rk; and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.). less
• Anesthesiology. 2016 Dec 1; 125 (6): 1113-1120.

BackgroundWe tested the hypothesis that an electronic alert for a "double low" of mean arterial pressure less than 75 mmHg and a bispectral index less than 45 reduces the primary outcome of 90-day mortality.MethodsAdults having noncardiac surgery were randomized to receive either intraoperative alerts for double-low events or no alerts. Anesthesiologists were not blinded and not required to alter care based upon the alerts. The primary outcome was all-cause 90-day mortality.ResultsPatients (20,239) were randomized over 33 months, and 19,092 were analyzed. After adjusting for age, comorbidities, and perioperative factors, patients with more than 60 min of cumulative double-low time were twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P = 0.005). The median number of double-low minutes (quartiles) was only slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min. Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the control arm. The difference in percent mortality was 0.18% (99% CI, -0.25 to 0.61).ConclusionsNinety-day mortality was not significantly lower in patients cared for by anesthesiologists who received automated alerts to double-low states. Prolonged cumulative double-low conditions were strongly associated with mortality.

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