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Letters to the Editor |
Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, 150 Du Cane Road, London W12 0HS, UK
Received 10 June 2008; accepted 11 June 2008.
* Corresponding author. Tel.: +44 20 8383 1000. (Email: omangoush{at}yahoo.co.uk).
Key Words: Heparin-bonded circuit • Cardiopulmonary bypass • Perfusion
I thank Ranucci for his interest and comments [1] about our recently published meta-analysis of the outcome of heparin-bonded circuits [2]. This letter is in response to his comments.
Ranucci asked why we elected to exclude RCT used postoperative autotransfusion? The reason was explained in the last paragraph of the heterogeneity section of our article. If we do not exclude these studies, there will be a big disparity in the blood transfusion between studies used and studies not used by the technique.
He asked, how do we know if RCT used an autotransfusion technique? The manuscripts of all potential studies were scrutinized independently by two authors, and if postoperative autotransfusion was not mentioned, that means the technique was not used. If it was mentioned, but not clear from the manuscript, the author of the manuscript would have been contacted for clarification.
He also claims that the study by McCarthy et al. [3], which was excluded from the analysis, did not state that they have used the autotransfusion technique. This is not true, as this was clearly stated at the end of the result section of that article. They have autotransfused postoperative blood loss in the first 8 h.
Ranucci stated in his letter that in his study [4], which was included in our analysis, he used the same protocol of Wildevuur et al. [5] who used postoperative autotransfusion and therefore we should have not included his study [4]. In Ranucci's manuscript he did not mention this fact. Therefore, there was no way for us to guess that. Actually, the Wildevuur study was not referred to in his material and methods section at all. He only made reference to this study on two occasions, one at the introduction and one at the comment sections. On both occasions he discussed the result of the study, but made no reference to the protocol in question.
He claims that the study by Baufreton et al. cited as reference number 5 in his letter, which was included in our analysis, was an arm of a bigger study by Wildevuur et al. [5], which was excluded due to the use of postoperative blood transfusion. In the Baufreton et al. study there was no mention of postoperative autotransfusion and there was no indication that these patients came from another study population. There was no reference to the Wildevuur study in their manuscript. This might be explained by the fact that both studies were accepted at different journals at the same time with only 2 days difference.
The conclusion Ranucci reached is not valid as it was based on simple analysis, as he described, and this defeats the object of systemic meta-analysis. Heterogeneity is a major problem in a systematic review and it can result in a wrong conclusion, therefore excluding a group of studies might be important to avoid such a problem. Poor reporting of surgical RCT is a known problem, which might lead to some mistakes and confusion when reporting systematic reviews.
References
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