Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta-analysis

Area of Science:

• Transfusion Medicine
• Cardiovascular Surgery
• Critical Care

Background:

• Intraoperative blood salvage using cell saver (CS) is employed in cardiac surgery to reduce allogeneic blood product transfusions.
• Evidence regarding the efficacy of CS in modifying transfusion requirements for red blood cells (RBCs), platelets, and fresh frozen plasma (FFP) remains debated.

Purpose of the Study:

• To conduct a systematic review and meta-analysis of randomized clinical trials (RCTs).
• To compare transfusion rates of RBCs, platelets, and FFP between cell saver (CS) and standard care in adult cardiac surgery patients.

Main Methods:

• Systematic search of MEDLINE, Cochrane CENTRAL, and American Society of Hematology databases, including bibliographies of relevant studies.
• Random-effect model meta-analysis of 15 selected RCTs.
• Assessment of publication bias using funnel plots and Egger's test.

Main Results:

• Cell saver use did not significantly decrease RBC transfusion rates (OR: 0.69; 95% CI: 0.48-1.00), with substantial heterogeneity (I²=60%) explained by publication year.
• Platelet transfusion rates were lower in the CS group but not statistically significant (OR: 0.83; 95% CI: 0.57-1.2; I²=0%).
• FFP transfusion rates were numerically higher in the CS group, but the difference was not statistically significant (OR: 1.26; 95% CI: 0.82-1.94; I²=15%).

Conclusions:

• Cell saver (CS) utilization during cardiac surgery does not demonstrate a significant impact on the rates of red blood cell, platelet, or fresh frozen plasma transfusion.
• Study limitations necessitate cautious interpretation of findings.
• The heterogeneity observed, particularly in RBC transfusion rates, highlights the need for further investigation into factors influencing CS effectiveness.