Clinical Effectiveness of Acute Normovolemic Hemodilution in Cardiac Surgery: A Systematic Review and Meta-analysis

doi:10.1213/ane.0000000000008221

Cardiothoracic & vascular anesthesia

Clinical Effectiveness of Acute Normovolemic Hemodilution in Cardiac Surgery: A Systematic Review and Meta-analysis

Anesth AnalgPublished 13 Jul 2026Systematic review and meta-analysis of randomised trials and matched cohort studies

Pooled resultResultRelative risk 0.85 95% CI 0.75–0.96

Read the original article ↗PubMed

Cite

Authors' conclusion

ANH significantly reduces the need for allogeneic transfusions while maintaining a favorable safety profile for patients undergoing cardiac surgery.

Study context

Population: Adults undergoing cardiac surgery19 studies (15 randomized controlled trials (RCTs), 4 cohorts)
Participants: 9,418 adults

Comparison: Acute normovolemic hemodilution (ANH) vs standard intraoperative care
Outcome: Incidence of allogeneic RBC transfusion

Methodological detailsDerSimonian-Laird random-effects models

DerSimonian-Laird random-effects models

Pooled result

As reported in the abstract

Relative risk

0.85

95% CI 0.75–0.96

P = 0.01

By group

ANH27.6%

Control31.5%

ANH vs Control

RR 0.85 (95% CI 0.75–0.96); P = 0.01

Further pooled results

Allogeneic red blood cell (RBC) transfusion, crystalloid-based protocols (subgroup)

Transfusion reduction more evident in crystalloid-based protocols, RR (95% CI): RR = 0.72, 95% CI [0.54-0.96], P = .026

Allogeneic RBC transfusion, on-pump surgeries (subgroup)

Transfusion reduction more evident in on-pump surgeries, RR (95% CI): RR = 0.86, 95% CI [0.76-0.97], P = .01

Allogeneic RBC transfusion, matched cohort analyses

Matched cohort analyses also confirmed the benefit, RR (95% CI): RR = 0.87, 95% CI [0.81-0.94], P = .001

Allogeneic RBC transfusion, RCT-only analysis

RCT-only analysis showed a nonsignificant difference, RR (95% CI): RR = 0.81, 95% CI [0.64-1.02], P = .07

Hematocrit, hemoglobin, FFP transfusion

No significant differences

Safety

Renal dysfunction, MI, stroke, mortality

No significant differences

Original publication

Clinical Effectiveness of Acute Normovolemic Hemodilution in Cardiac Surgery: A Systematic Review and Meta-analysis. Anesth Analg. Published 13 July 2026. doi:10.1213/ane.0000000000008221

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →