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Red blood cell transfusion threshold after pediatric cardiac surgery: A systematic review and meta-analysis
Xicheng Deng1, Yefeng Wang1, Peng Huang1
1Heart Center.
Insights
Restrictive red blood cell transfusion strategies are as effective as liberal ones for pediatric cardiac surgery patients. This systematic review found no significant differences in outcomes like ICU stay or mortality.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transfusion Medicine
Background:
- Restrictive red blood cell transfusion strategies are standard in adult cardiac surgery.
- Their applicability to pediatric cardiac surgery remains uncertain.
- This study evaluates restrictive versus liberal transfusion thresholds in pediatric cardiac patients.
Purpose of the Study:
- To determine the effect of postoperative restrictive transfusion thresholds on clinical outcomes in pediatric cardiac surgery.
- To synthesize evidence from randomized controlled trials (RCTs) and observational studies.
- To assess impacts on intensive care unit (ICU) stay, hospital stay, ventilation duration, lactate levels, and mortality.
Main Methods:
- Systematic review and meta-analysis of RCTs and observational studies.
- Searched Cochrane, MEDLINE, EMBASE, and ClinicalTrials.gov up to October 26, 2017.
- Included four RCTs involving 454 pediatric cardiac surgery patients; no observational studies met criteria.
Main Results:
- No significant differences were found between liberal and restrictive transfusion thresholds for ICU stay (SMD, 0.007; P=.94).
- Outcomes including hospital stay (SMD, -0.062; P=.57), ventilation duration (SMD, -0.015; P=.90), lactate levels (SMD, 0.071; P=.63), and mortality (RR, 0.49; P=.31) also showed no significant differences.
- No inter-trial heterogeneity or significant publication bias was detected.
Conclusions:
- Limited RCT evidence suggests restrictive transfusion thresholds are non-inferior to liberal thresholds in pediatric cardiac surgery.
- Key outcomes such as ICU stay and mortality were comparable between strategies.
- Further high-quality RCTs are needed to confirm these findings and guide clinical practice.
Background:
Restrictive red blood cell transfusion strategy is implemented to minimize risk following allogeneic blood transfusion in adult cardiac surgery. However, it is still unclear if it can be applied to pediatric cardiac patients. The purpose of this systematic review and meta-analysis was to determine the effect of postoperative restrictive transfusion thresholds on clinical outcomes based on up-to-date results of randomized controlled trials (RCTs) and observational studies in pediatric cardiac surgery.
Method:
We searched for RCTs and observational studies in the following databases: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to October 26, 2017. We also searched reference lists of published guidelines, reviews, and relevant articles, as well as conference proceedings. No language restrictions were applied and no observational study met the inclusion criteria.
Results:
Four RCTs on cardiac surgery involving 454 patients were included. There were no differences in the pooled fixed effects of intensive care unit (ICU) stay between the liberal and restrictive transfusion thresholds (standardized mean difference SMD, 0.007; 95% confidence interval CI, -0.18-0.19; P = .94). There were also no differences in the length of hospital stay (SMD, -0.062; 95% CI, -0.28-0.15; P = .57), ventilation duration (SMD, -0.015; 95% CI, -0.25-0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95% CI, -0.22-0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI, 0.13-1.94; P = .31). There was no inter-trial heterogeneity for any pooled analysis. Publication bias was tested using Egger, Begg, or the trim-and-fill test, and the results indicated no significant publication bias.
Conclusion:
Evidence from RCTs in pediatric cardiac surgery, though limited, showed non-inferiority of restrictive thresholds over liberal thresholds in length of ICU stay and other outcomes following red blood cell transfusion. Further high-quality RCTs are necessary to confirm the findings.
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