TY - JOUR
T1 - Ultrafiltration in cardiac surgery
T2 - Results of a systematic review and meta-analysis
AU - Hensley, Nadia B.
AU - Colao, Joseph A.
AU - Zorrilla-Vaca, Andres
AU - Nanavati, Julie
AU - Lawton, Jennifer S.
AU - Raphael, Jacob
AU - Mazzeffi, Michael A.
AU - Wierschke, Chad
AU - Kostibas, Megan P.
AU - Cho, Brian C.
AU - Frank, Steven M.
AU - Grant, Michael C.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - Background: Ultrafiltration is used with cardiopulmonary bypass to reduce the effects of hemodilution and restore electrolyte balance. We performed a systematic review and meta-analysis to analyze the effect of conventional and modified ultrafiltration on intraoperative blood transfusion. Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, we systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library to perform a meta-analysis of studies of randomized controlled trials (RCTs) and observational studies evaluating conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) on the primary outcome of intraoperative red cell transfusions. Results: A total of 7 RCTs (n = 928) were included, comparing modified ultrafiltration (n = 473 patients) to controls (n = 455 patients) and 2 observational studies (n = 47,007), comparing conventional ultrafiltration (n = 21,748) to controls (n = 25,427). Overall, MUF was associated with transfusion of fewer intraoperative red cell units per patient (n = 7); MD −0.73 units; 95% CI −1.12 to −0.35 p = 0.04; p for heterogeneity = 0.0001, I 2 = 55%) compared to controls. CUF was no difference in intraoperative red cell transfusions compared to controls (n = 2); OR 3.09; 95% CI 0.26–36.59; p = 0.37; p for heterogeneity = 0.94, I 2 = 0%. Review of the included observational studies revealed an association between larger volumes (>2.2 L in a 70 kg patient) of CUF and risk of acute kidney injury (AKI). Conclusion: The results of this systematic review and meta-analysis suggest that MUF is associated with fewer intraoperative red cell transfusions. Based on limited studies, CUF does not appear to be associated with a difference in intraoperative red cell transfusion.
AB - Background: Ultrafiltration is used with cardiopulmonary bypass to reduce the effects of hemodilution and restore electrolyte balance. We performed a systematic review and meta-analysis to analyze the effect of conventional and modified ultrafiltration on intraoperative blood transfusion. Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, we systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library to perform a meta-analysis of studies of randomized controlled trials (RCTs) and observational studies evaluating conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) on the primary outcome of intraoperative red cell transfusions. Results: A total of 7 RCTs (n = 928) were included, comparing modified ultrafiltration (n = 473 patients) to controls (n = 455 patients) and 2 observational studies (n = 47,007), comparing conventional ultrafiltration (n = 21,748) to controls (n = 25,427). Overall, MUF was associated with transfusion of fewer intraoperative red cell units per patient (n = 7); MD −0.73 units; 95% CI −1.12 to −0.35 p = 0.04; p for heterogeneity = 0.0001, I 2 = 55%) compared to controls. CUF was no difference in intraoperative red cell transfusions compared to controls (n = 2); OR 3.09; 95% CI 0.26–36.59; p = 0.37; p for heterogeneity = 0.94, I 2 = 0%. Review of the included observational studies revealed an association between larger volumes (>2.2 L in a 70 kg patient) of CUF and risk of acute kidney injury (AKI). Conclusion: The results of this systematic review and meta-analysis suggest that MUF is associated with fewer intraoperative red cell transfusions. Based on limited studies, CUF does not appear to be associated with a difference in intraoperative red cell transfusion.
KW - cardiopulmonary bypass
KW - conventional ultrafiltration
KW - modified ultrafiltration
KW - red cell transfusion
KW - ultrafiltration
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U2 - 10.1177/02676591231157970
DO - 10.1177/02676591231157970
M3 - Article
C2 - 36795704
AN - SCOPUS:85148459914
SN - 0267-6591
JO - Perfusion (United Kingdom)
JF - Perfusion (United Kingdom)
ER -