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Retrograde autologous priming in cardiac surgery: a systematic review and meta-analysis
Saurabh Gupta1,2, Charlotte McEwen3, Ameen Basha4
1Department of Surgery, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada.
Insights
Retroautologous priming (RAP) during cardiopulmonary bypass significantly reduces the need for blood transfusions. This blood conservation strategy is supported by a meta-analysis of RCTs and observational studies.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- Cardiopulmonary bypass is a critical procedure in cardiac surgery.
- Guidelines suggest retrograde autologous priming (RAP) to optimize bypass circuits.
- The clinical effectiveness and safety of RAP require further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the impact of RAP on transfusion requirements.
- To evaluate the effects of RAP on patient morbidity and mortality.
Main Methods:
- A comprehensive search of multiple databases (Cochrane, Medline, Embase, etc.) was conducted.
- Included randomized controlled trials (RCTs) and observational studies comparing RAP with no-RAP.
- Data were extracted and analyzed using a random effects model for meta-analysis.
Main Results:
- Twelve RCTs (1206 patients) and 17 observational studies (3565 patients) were included.
- RAP significantly reduced the proportion of patients requiring blood transfusions (RCTs: RR 0.58; observational: RR 0.65).
- The number of blood units transfused per patient was also lower with RAP.
Conclusions:
- This meta-analysis provides evidence supporting the use of RAP.
- RAP demonstrates efficacy as a blood conservation strategy during cardiopulmonary bypass.
- The findings suggest a reduction in transfusion needs when employing RAP.
Objectives:
Guidelines recommend retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit. However, the efficacy and safety of RAP is not well-established. We performed a systematic review and meta-analysis to determine the effects of RAP on transfusion requirements, morbidity and mortality.
Methods:
We searched Cochrane Central Register of Controlled Trials, Medline, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature and Embase for randomized controlled trials (RCTs) and observational studies comparing RAP to no-RAP. We performed title and abstract review, full-text screening, data extraction and risk of bias assessment independently and in duplicate. We pooled data using a random effects model.
Results:
Twelve RCTs (n = 1206) and 17 observational studies (n = 3565) were included. Fewer patients required blood transfusions with RAP [RCTs; risk ratio 0.58 [95% confidence interval (CI): 0.51, 0.65], P < 0.001, and observational studies; risk ratio 0.65 [95% CI: 0.53, 0.80], P < 0.001]. The number of units transfused per patient was also lower among patients who underwent RAP (RCTs; mean difference -0.38 unit [95% CI: -0.72, -0.04], P = 0.03, and observational studies; mean difference -1.03 unit [95% CI: -1.76, -0.29], P < 0.006).
Conclusions:
This meta-analysis supports the use of RAP as a blood conservation strategy since its use during cardiopulmonary bypass appears to reduce transfusion requirements.
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