Magic Bullets in Cardiac Anesthesia and Intensive Care

Even if the first quasi-randomized study in history was published in 1747, there is still a need for evidence-based medicine. In the specific field of cardiac anesthesia, there are few magic bullets (ie, drugs/techniques/strategies that might reduce perioperative mortality), and a recent international consensus conference attempted to list them all. In the absence of evidence-based medicine, medical decisions are made by eminence, experience, or physiopathologic reasoning. Even if increased or decreased mortality could be observed when administering almost every drug used in the current clinical context, if correctly studied, research is slowed by bureaucracy, which, together with ignorance, is indirectly killing thousands of patients per year. Patients should be fully aware of the reduced complication rates and the improved outcomes that occur in patients involved in randomized “researcher-driven” clinical trials, the so-called “Hawthorne effect.” In conclusion, physicians have to do their best although they sometimes have little information. Their ability must counteract the lack of scientific evidences. Caring for critical patients involves making decisions based on realistic tradeoffs of clinical benefit and side effects, but too often these choices are made on the basis of extrapolations and educated guesses.