Related Experiment Video
Updated: Jul 13, 2025
A Recovery Cardiopulmonary Bypass Model Without Transfusion or Inotropic Agents in Rats
Published on: March 23, 2018
Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors
Yudo P Bhirowo1, Yusuf K Raksawardana2, Budi Y Setianto3
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Jl. Kesehatan No. 1, Sendowo, Sekip Utara, Depok District, Sleman Regency, Yogyakarta, 55281, Indonesia. bhirowo@ugm.ac.id.
Insights
This systematic review found that factors like pump type and blood management strategies significantly impact hemolysis during cardiopulmonary bypass (CPB). Standardized guidelines are needed for future research on reducing CPB-related hemolysis.
Area of Science:
- Cardiovascular Surgery
- Hemolysis Research
- Medical Device Engineering
Background:
- Cardiopulmonary bypass (CPB) is essential in cardiac surgery but can cause complications like hemolysis.
- Currently, no standardized methods exist to mitigate hemolysis during CPB procedures.
- This review systematically analyzes factors influencing hemolysis in CPB to identify reduction strategies.
Approach:
- Conducted a systematic review of randomized controlled trials (RCTs) from 1990-2021 on PubMed and Cochrane CENTRAL.
- Included studies focused on CPB interventions in cardiac surgery patients, measuring hemolysis as an outcome.
- Excluded studies with preoperative hematological disorders, prosthetic valves, or specific surgical approaches.
Key Points:
- Centrifugal pumps, separated suctioned blood, CPB alternatives, and mini extracorporeal circulation (MiniECC) showed significant reductions in hemolysis markers (PFHb, Hp, LDH).
- Increased pulsatility and vacuum-assisted venous drainage (VAVD) were associated with higher hemolysis.
- Findings highlight the impact of various CPB parameters on hemolysis, with 75% of included surgeries being coronary revascularization.
Conclusions:
- Hemolysis during CPB is multifactorial, and combined efforts to reduce it can be beneficial.
- Significant heterogeneity exists due to the lack of standardized CPB protocols.
- Further research with standardized guidelines and specific meta-analysis parameters is crucial for comparable studies and effective hemolysis reduction.
Background:
The use of cardiopulmonary bypass (CPB) is almost inevitable in cardiac surgery. However, it can cause complications, including hemolysis. Until now, there have not been any standards for reducing hemolysis from CPB. Therefore, this systematic review was conducted to determine the factors that increase or reduce hemolysis in the use of CPB.
Methods:
Keywords Earches (cardiac surgery AND cardiopulmonary bypass AND hemolysis) were done on PubMed databases and Cochrane CENTRAL from 1990-2021 for published randomized controlled trials (RCTs) that studied interventions on CPB, in cardiac surgery patients, and measured hemolysis as one of the outcomes. Studies involving patients with preoperative hematological disorders, prosthetic valves, preoperative use of intra-aortic balloon pumps and extracorporeal circulation, emergency and minimally invasive surgery are excluded RESULTS: The search yielded 64 studies that met the inclusion criteria, which involved a total of 3,434 patients. The most common surgery was coronary revascularization (75%). Out of 64 studies, 33 divided into 7 analyses. Remaining 31 studies were synthesized qualitatively. Significant decreases were found in centrifugal vs roller pumps for PFHb (p = 0.0006) and Hp (p < 0.0001) outcomes, separated vs combined suctioned blood (p = 0.003), CPB alternatives vs conventional CPB (p < 0.0001), and mini extracorporeal circulation (MiniECC) vs conventional CPB for LDH (p = 0.0008). Significant increases were found in pulsatility (p = 0.03) and vacuum-assisted venous drainage (VAVD) vs gravity-assisted venous drainage (GAVD) (p = 0.002).
Conclusion:
The review shows that hemolysis could be caused by several factors and efforts have been made to reduce it, combining significant efforts could be beneficial. However, this review has limitations, such as heterogeneity due to no standards available for conducting CPB. Therefore, further research with standardized guidelines for CPB is needed to yield more comparable studies. Meta-analyses with more specific parameters should be done to minimize heterogeneity.
