The association of ultrafiltration with the outcomes of cardiopulmonary bypass surgery in adults with cardiovascular disease: The result of a systematic review and meta-analysis

Abstract

Introduction: Previous studies have shown that ultrafiltration (UF) is associated with improved minor and major outcomes of cardiopulmonary bypass (CPB) by improving tissue perfusion as well as lowering the patient’s hematocrit and blood loss and finally reducing the mortality. This meta-analysis aimed to pool the data of the previous studies on the association between using UF in the perioperative period and clinical outcomes in adult patients undergoing CPB. Methods: We searched Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to June 29th, 2019. The studies that assessed the association of UF with the outcomes of CPB in adults were eligible for inclusion. We did not restrict the search to time or language. Two independent investigators screened the identified studies and extracted the data in duplicate. We analyzed sixteen different clinical outcomes. Heterogeneity was assessed using Cochrane collaboration tools. Results: Primary search identified 1114 studies from which 22 studies with 8538 patients were found eligible for inclusion. Results showed a statistically significant reduction in perioperative bleeding (-107.59 (ml) CI [-179.01, -36.18]), red blood cell transfusion (-0.76 (unit/patient) CI [-1.02,-0.51]) and ICU length of stay (-0.16 (day) CI [-0.31,-0.01]) in the group with UF compared to the control group. Aortic cross-clamp time, CPB time, ventilation time, hospital length of stay, as well as number of myocardial infarctions, chest infection, perioperative arrhythmia, low cardiac output, stroke/TIA, acute renal failure, intra-aortic balloon pump, reoperation and mortality was not statistically different between the two groups (p=>0.05). Conclusion: Using UF in adult patients undergoing CPB is associated with reduced perioperative bleeding, red blood cell transfusion, and ICU length of stay. However, the use of UF was not associated with the reduction of major cardiovascular outcomes.