Ultrafiltration in cardiac surgery: Results of a systematic review and meta-analysis

Nadia B. Hensley, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Joseph A. Colao, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Andres Zorrilla-Vaca, Department of Anesthesiology, Perioperative and Pain Medicine, 1861Brigham and Women's Hospital, Boston, MA, USA.
Julie Nanavati, Welch Medical Library, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jennifer S. Lawton, Department of Surgery, Division of Cardiac Surgery, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jacob Raphael, Sidney Kimmel Medical College, Department of Anesthesiology, 12313Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Michael A. Mazzeffi, Department of Anesthesiology, George Washington University Hospital, Washington, DC, USA.
Chad Wierschke, Department of Surgery, Perfusion Division, Johns Hopkins Hospital, Baltimore, MD, USA.
Megan P. Kostibas, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Brian C. Cho, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Steven M. Frank, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Michael C. Grant, Department of Anesthesiology and Critical Care Medicine, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

2-16-2023

Journal

Perfusion

DOI

10.1177/02676591231157970

Keywords

cardiopulmonary bypass; conventional ultrafiltration; modified ultrafiltration; red cell transfusion; ultrafiltration

Abstract

: 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.: 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.: A total of 7 RCTs ( = 928) were included, comparing modified ultrafiltration ( = 473 patients) to controls ( = 455 patients) and 2 observational studies ( = 47,007), comparing conventional ultrafiltration ( = 21,748) to controls ( = 25,427). Overall, MUF was associated with transfusion of fewer intraoperative red cell units per patient ( = 7); MD -0.73 units; 95% CI -1.12 to -0.35 = 0.04; for heterogeneity = 0.0001, = 55%) compared to controls. CUF was no difference in intraoperative red cell transfusions compared to controls ( = 2); OR 3.09; 95% CI 0.26-36.59; = 0.37; for heterogeneity = 0.94, = 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).: 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.

Department

Anesthesiology and Critical Care Medicine

Link to Full Text

Share

COinS