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Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors
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 factor...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10571250/ https://www.ncbi.nlm.nih.gov/pubmed/37833747 http://dx.doi.org/10.1186/s13019-023-02406-y |
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author | Bhirowo, Yudo P. Raksawardana, Yusuf K. Setianto, Budi Y. Sudadi, Sudadi Tandean, Tommy N. Zaharo, Alfia F. Ramsi, Irhash F. Kusumawardani, Hening T. Triyono, Teguh |
author_facet | Bhirowo, Yudo P. Raksawardana, Yusuf K. Setianto, Budi Y. Sudadi, Sudadi Tandean, Tommy N. Zaharo, Alfia F. Ramsi, Irhash F. Kusumawardani, Hening T. Triyono, Teguh |
author_sort | Bhirowo, Yudo P. |
collection | PubMed |
description | 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-023-02406-y. |
format | Online Article Text |
id | pubmed-10571250 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-105712502023-10-14 Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors Bhirowo, Yudo P. Raksawardana, Yusuf K. Setianto, Budi Y. Sudadi, Sudadi Tandean, Tommy N. Zaharo, Alfia F. Ramsi, Irhash F. Kusumawardani, Hening T. Triyono, Teguh J Cardiothorac Surg Review 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-023-02406-y. BioMed Central 2023-10-13 /pmc/articles/PMC10571250/ /pubmed/37833747 http://dx.doi.org/10.1186/s13019-023-02406-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Review Bhirowo, Yudo P. Raksawardana, Yusuf K. Setianto, Budi Y. Sudadi, Sudadi Tandean, Tommy N. Zaharo, Alfia F. Ramsi, Irhash F. Kusumawardani, Hening T. Triyono, Teguh Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title | Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title_full | Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title_fullStr | Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title_full_unstemmed | Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title_short | Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
title_sort | hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10571250/ https://www.ncbi.nlm.nih.gov/pubmed/37833747 http://dx.doi.org/10.1186/s13019-023-02406-y |
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