N-acetylcysteine to reduce mortality in cardiac surgery

Abstract

Acute kidney injury is a frequent complication of cardiac surgery that has significant prognostic implications. Therefore, there has been extensive research to find effective interventions for preventing this important complication. N-acetylcysteine has anti-inflammatory, antioxidant, and renal vasodilator properties that may mitigate several mechanisms of acute kidney injury after cardiac surgery. Consequently, it has been evaluated as a potential therapeutic agent in several randomized controlled trials in cardiac surgery. While a small single-center randomized controlled trial found a survival benefit with perioperative N-acetylcysteine treatment, these benefits were not confirmed in other trials or in meta-analyses of these trials. Conversely, N-acetylcysteine use during cardiac surgery appears safe. While some trials have observed increased perioperative blood loss with N-acetylcysteine use, this risk was not confirmed in a meta-analysis of contemporary trials. Overall, there is weak to no evidence for recommending N-acetylcysteine as a treatment to improve survival in patients undergoing cardiac surgery.