Apparent duplication from anesthesiology journal puts heart paper into intensive care

A heart journal has issued an expression of concern about a 2017 paper which looks suspiciously like a 2016 article by some of the same researchers that appeared in an anesthesiology publication. 

The 2017 paper, “Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia after pediatric cardiac surgery,” was written by a group led by Doaa Mohamed El Amrousy, of Tanta University Hospital in Egypt.

Several months earlier, El Amrousy and two of his co-authors, Nagat S. El-Shmaa and Wael El Feky, published a similar article in the Annals of Cardiac Anesthesia, titled “The efficacy of pre-emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery.”

How similar? Apparently too much.

According to the expression of concern

The article “Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery,” by El Amrousy et al, which published on March 1, 2017, and appeared in the March 15, 2017 issue of the journal, (J Am Heart Assoc. 2017;6:e004780. DOI: 10.1161/JAHA.116.004780) contains substantial overlap with a previously published article by El‐Shmaa et al, “The efficacy of pre‑emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery,” which published online in Annals of Cardiac Anaesthesia on October 7, 2016 (Ann Card Anaesth. 2016 Oct‐Dec;19(4):614‐620).

Specifically, certain elements in the demographics and results presented in Tables 1‐3 in both articles appear to be nearly identical. These included the sex ratio and preoperative heart rate of the placebo/control groups in Table 1 of each article; the intraoperative heart rate of the placebo/control groups in Table 2 of each article; and the Vasoactive Inotropic Score, Ventilation Time, the Pediatric Cardiac Care Unit Length of Stay, the Hospital Length of Stay, and incidence of mortality/bradycardia/hypotension in Table 3 of each article.

We are communicating with the authors involved in these publications. We are publishing this Expression of Concern while we await the outcome of these communications and to indicate that the data and statements in the listed publications may not be reliable.

The similarities don’t end with the tables. Here’s the first part of the methods section of the JAHA article, which has been cited 11 times, according to Clarivate Analytics Web of Science: 

This is a prospective randomized controlled study conducted at a university hospital and was carried out on 90 children who underwent corrective surgery for congenital heart disease (CHD) between March 2014 and April 2016 after approval by the hospital Ethical Committee and obtaining written informed consents from the parents of studied children.

And here’s the introduction to the methods section in the ACA article, which has been cited 12 times: 

This is a prospective controlled study conducted at the Tanta University Hospital on ninety patients of both sexes during the period from October 2010 to March 2014 after obtaining approval from the hospital’s Ethical Committee, and a written informed consent of the parents was obtained. The CONSORT 2010 statement was followed in reporting this study.

Another red flag. From the JAHA paper: 

The care team and outcome assessors were blinded to the study except the anesthesiologist, who gave the drug intraoperatively, and he was not a part of the study. Additional bolus doses of midazolam and fentanyl were given when needed. Bispectral index was used to monitor the sedation in the study groups. Data were collected in both the operating room and in the ICU.

From the ACA paper: 

The decision whether patients would receive dexmedetomidine, amiodarone, or not was a clinical decision and based entirely on the preference of a primary cardiac anesthesiologist. 

Top-up bolus doses of fentanyl and midazolam were given according to the need in the study groups. Sedation was monitored with bispectral index (BIS). Data collection was done in the operative room (OR) and in pediatric cardiac Intensive Care Unit (PCICU).

We mailed El-Shmaa and El Amrousy for comment. The latter responded, telling us: 

This matter is complicated and we are communicating now with both journals to solve this problem. We appreciate if you do not publish about it until we finish these communications and reach to an outcome. Then I will comment on the whole matter.

Barry London, the editor in chief of the JAHA, did not respond to our request for comment.

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