HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Munir Boodhwani Fraser D. Rubens Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boodhwani, M. Articles by Rubens, F. D. Search for Related Content PubMed PubMed Citation Articles by Boodhwani, M. Articles by Rubens, F. D. Related Collections Extracorporeal circulation

Eur J Cardiothorac Surg 2006;30:892-897
© 2006 Elsevier Science NL

Ultrafiltration reduces blood transfusions following cardiac surgery: a meta-analysis

^a Division of Cardiac Surgery, University of Ottawa Heart Institute, Canada
^b Division of Clinical Research, University of Ottawa Heart Institute, Canada

Received 31 March 2006; received in revised form 18 August 2006; accepted 15 September 2006.

^_* Corresponding author. Address: H3401, 40 Ruskin Street, Ottawa, Ont. K1Y 4W7, Canada. Tel.: +1 613 761 4720; fax: +1 613 761 4713. (Email: frubens{at}ottawaheart.ca).

Background: Although used routinely in pediatric patients, ultrafiltration techniques that reverse hemodilution are infrequently used in adults. Data from small, unblinded clinical trials suggest that the use of ultrafiltration can reduce inflammatory mediators, improve cardiac function, and reduce hemodilution. We conducted a meta-analysis of randomized trials to evaluate the effects of ultrafiltration on blood transfusions and blood loss following adult cardiac surgery. Methods: Medline, EMBASE, and Cochrane databases were searched and randomized controlled trials evaluating modified and/or conventional ultrafiltration, meeting pre-determined selection criteria, were obtained. Quality evaluation and data extraction were performed by two independent observers blinded to study source. Random effects models were used to determine pooled effect estimates and sources of heterogeneity were explored using meta-regression. Results: One hundred and thirty two studies were screened and 10 randomized trials evaluating 1004 patients (control, n = 495; ultrafiltration, n = 509) were identified of which only two were double-blinded. The use of ultrafiltration was associated with a reduction in postoperative blood transfusions (weighted mean difference [95% CI] of –0.73 units [–1.16, –0.31]; p = 0.001). This reduction was greater in studies evaluating modified ultrafiltration. Use of ultrafiltration was also associated with reduced postoperative bleeding (–70 ml, [–118, –21]; p = 0.005), which was driven primarily by trials evaluating modified rather than conventional ultrafiltration. Conclusions: Use of ultrafiltration is associated with a significant reduction in postoperative blood transfusions as well as reduced bleeding in adults undergoing cardiac surgery. The efficacy and cost-effectiveness of ultrafiltration as a blood conservations strategy should be evaluated in a large, randomized, double-blinded study.

Key Words: Ultrafiltration • Meta-analysis • Randomized controlled trials • Blood transfusion • Bleeding

This article has been cited by other articles:

				F. W. Maddux, T. A. Dickinson, D. Rilla, R. W. Kamienski, S. P. Saha, F. Eales, A. Rego, H. W. Donias, S. L. Crutchfield, and R. A. Hardin Institutional Variability of Intraoperative Red Blood Cell Utilization in Coronary Artery Bypass Graft Surgery American Journal of Medical Quality, September 1, 2009; 24(5): 403 - 411. [Abstract] [PDF]

				R. A. Baker Suction, Salvage, Sutures, and Potions: Blood Management Post-Aprotinin Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2009; 13(2): 122 - 126. [Abstract] [PDF]