Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies

Transfusion ◽  
2016 ◽  
Vol 56 (8) ◽  
pp. 2146-2153 ◽  
Author(s):  
Francesco Vasques ◽  
Eeva-Maija Kinnunen ◽  
Marek Pol ◽  
Giovanni Mariscalco ◽  
Francesco Onorati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Adult Cardiac Surgery

scholarly journals Do continuous forms of intra-operative ultrafiltration enhance recovery after adult cardiac surgery with cardiopulmonary bypass? A protocol for systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Joel Bierer ◽  
David Horne ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Leah Boulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inflammatory Syndrome ◽  
Adult Cardiac Surgery

Abstract Background Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a systemic inflammatory syndrome that adversely impacts cardiopulmonary function and can contribute to prolonged postoperative recovery. Intra-operative ultrafiltration during CPB is a strategy developed by pediatric cardiac specialists, aiming to dampen the inflammatory syndrome by removing circulating cytokines and improving coagulation profiles during the cardiac operation. Although ultrafiltration is commonly used in the pediatric population, it is not routinely used in the adult population. This study aims to evaluate if randomized evidence supports the use of continuous intra-operative ultrafiltration to enhance recovery for adults undergoing cardiac surgery with CPB. Methods This systematic review and meta-analysis will include randomized controlled trials (RCT) that feature continuous forms of ultrafiltration during adult cardiac surgery with CPB, specifically assessing for benefit in mortality rates, invasive ventilation time and intensive care unit length of stay (ICU LOS). Relevant RCTs will be retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus, by a pre-defined search strategy. Search results will be screened for inclusion and exclusion criteria by two independent persons with consensus. Selected RCTs will have study demographics and outcome data extracted by two independent persons and transferred into RevMan. Risk of bias will be independently assessed by the Revised Cochrane Risk-of-Bias (RoB2) tool and studies rated as low-, some-, or high- risk of bias. Meta-analyses will compare the intervention of continuous ultrafiltration against comparators in terms of mortality, ventilation time, ICU LOS, and renal failure. Heterogeneity will be measured by the χ2 test and described by the I2 statistic. A sensitivity analysis will be completed by excluding included studies judged to have a high risk of bias. Summary of findings and certainty of the evidence, determined by the GRADE approach, will display the analysis findings. Discussion The findings of this systematic review and meta-analysis will summarize the evidence to date of continuous forms of ultrafiltration in adult cardiac surgery with CPB, to both inform adult cardiac specialists about this technique and identify critical questions for future research in this subject area. Systematic review registration This systematic review and meta-analysis is registered in PROSPERO CRD42020219309 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309). 

A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery

2019 ◽  
Vol 14 (5) ◽  
pp. 385-393 ◽  
Author(s):  
Kevin R. An ◽  
Ishtiaq A. Rahman ◽  
Derrick Y. Tam ◽  
Niv Ad ◽  
Subodh Verma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Efficacy And Safety ◽  
Aortic Cross Clamp ◽  
Output State ◽  
Adult Cardiac Surgery

Objective Del Nido cardioplegia (DC) has been used extensively in pediatric cardiac surgery but the efficacy and safety in adults remains uncertain. Our objective was to perform a systematic review and meta-analysis comparing DC and blood cardioplegia (BC) in our primary endpoint of 30-day or in-hospital mortality as well as other efficacy and safety endpoints. Methods Both MEDLINE and EMBASE were searched from 1996 to 2017 for studies comparing DC and BC. Data were extracted by 2 independent investigators and aggregated in a random effects model. Results One randomized controlled trial ( n = 89), 7 adjusted ( n = 1,104), and 5 unadjusted observational studies ( n = 717) were included. There was no difference in in-hospital mortality between DC and BC (relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; P = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]:−1.1 L, 95% CI, −1.6, −0.6; P < 0.0001), aortic cross-clamp time (MD: −8 minutes, 95% CI, −12, −3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD: −8 minutes, 95% CI, −14, −3; P = 0.03). DC reduced troponin release (standardized MD: −0.3, 95% CI, −0.5, −0.1; P = 0.001). In-hospital outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low cardiac output state, blood transfusion, reoperation rate, postoperative left ventricular EF, intensive care unit length of stay (LOS), and in-hospital LOS were comparable between groups. Conclusions DC is a safe alternative to BC in routine adult cardiac surgery. Its use is associated with reduction in CPB and aortic cross-clamp times and may potentially offer improved myocardial protection.

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