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Efficacy of intraoperative hemoadsorption in patients undergoing cardiac surgery, a meta-analysis
Karam R Motawea1, Louna Abouainain2, Amro Essam Amer3
1Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Insights
Intraoperative hemodsorption (HA) during cardiopulmonary bypass did not significantly improve mortality or major complications in cardiac surgery patients. While HA was associated with shorter ICU and hospital stays, routine use is not currently supported by evidence.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Biomaterials Science
Background:
- Cardiopulmonary bypass (CPB) is a critical component of cardiac surgery.
- Intraoperative hemodsorption (HA) is an adjunct therapy aimed at removing inflammatory mediators and toxins during CPB.
- The clinical benefit of HA in cardiac surgery remains under investigation.
Purpose of the Study:
- To compare clinical outcomes after CPB with and without intraoperative HA.
- To evaluate the impact of HA on mortality and major complications in cardiac surgery patients.
Main Methods:
- A systematic meta-analysis of randomized control trials (RCTs) was conducted.
- Searched PubMed, Scopus, and Web of Science for relevant RCTs.
- Included 16 RCTs with 851 patients (433 in HA group, 418 in control).
Main Results:
- No significant differences in 30-day mortality, major complications (stroke, renal failure, sepsis, etc.), or ICU scores were observed.
- HA was associated with decreased albumin levels at ICU admission (p=0.04).
- Significant reductions in length of ICU stay (p=0.03) and hospital stay (p=0.03) were noted with HA.
Conclusions:
- Current evidence does not support the routine use of intraoperative HA during CPB for improving clinical outcomes in cardiac surgery.
- Patient risk, procedure complexity, and cost-effectiveness should guide decisions on using HA.
- Further research may clarify the role of HA in specific patient populations or complex procedures.
Abstract:
ObjectivesComparing clinical outcomes after cardiopulmonary bypass with hemodsorption (HA) versus cardiopulmonary bypass without HA in patients undergoing cardiac surgery in terms of mortality and major complications.MethodsPubMed, Scopus, and Web of Science databases were searched for relevant randomized control trials (RCTs) that compared postoperative clinical outcomes between patients receiving intraoperative HA with cardiopulmonary bypass versus patients receiving cardiopulmonary bypass without intraoperative HA in cardiac surgery.ResultsSixteen RCTs with 851 patients (433 in the HA group and 418 in the control group), were included in our meta-analysis. Our meta-analysis found no significant differences between the intraoperative HA group and the control group in patients undergoing cardiac surgery in terms of 30-days/in-hospital mortality, new-onset atrial fibrillation, stroke or cerebrovascular events, postoperative delirium, renal failure/acute kidney injury, need for renal replacement, postoperative liver dysfunction, thrombocytopenia, bleeding, volume of blood loss, pneumonia, sepsis, respiratory insufficiency, duration of postoperative ventilation, distributive/septic shock, pericardial tamponade, need for extracorporeal membrane oxygenation (ECMO) support, sequential organ failure assessment (SOFA) score at ICU admission, plasma-free hemoglobin levels, and fibrinogen levels. However, the pooled analysis showed a significant association between HA and decreased albumin at ICU admission (MD = - 0.28, 95% CI [0.55 to 0.01], p-value = 0.04), decreased length of ICU stay (MD = -0.66, 95% CI [-1.24 to 0.08], p-value = 0.03), and decreased length of hospital stay (MD = -0.99, 95% CI [-1.88 to -0.10], p-value = 0.03).ConclusionOur findings suggest that there is not enough evidence to endorse the role of routine intraoperative HA during cardiopulmonary bypass in improving clinical outcomes after cardiac surgery. Factors such as patient risk profile, procedure complexity, and cost implications should be taken into account when considering this adjunct therapy.
