Hemodynamics, fluids & transfusion
Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis
Authors' conclusion
In adult patients undergoing cardiac surgery, a restrictive protocol integrating Hb values with a marker of organ hypoperfusion (ScvO2) reduces the number of RBC units transfused and the number of patients transfused at least once without apparent signals of harm.
Study context
- Population
- Adults undergoing cardiac surgery
- Participants
- 257 adults · 2 randomized controlled trials (RCTs)
- Comparison
- Hemoglobin (Hb) only vs Hb + ScvO2
- Outcome
- Number of RBC units transfused, number of patients transfused at least once, and average number of transfusions
Methodological detailstrial sequential analysis
- Trial sequential analysis
Pooled result
As reported in the abstract
Hb only vs Hb + ScvO2Relative risk (CI)P value
Overall number of RBC units transfused; I2 = 0%
1.57(1.33–1.85)
P < 0.0001Patients transfused at least once; I2 = 41%
1.33(1.16–1.53)
P < 0.0001Hb only vs Hb + ScvO2MD (CI)P value
Average number of transfusions; I2 = 66%
0.18(−0.11 to 0.47)
P = 0.24Further pooled results
Mortality
- Mortality not affected (RR: 1.29, [0.29-5.77]; p = 0.73)
- I2 = 0%
ICU LOS
- ICU LOS not affected (MD: −0.06 [−0.58 to 0.46]; p = 0.81)
- I2 = 0%
Hospital LOS
- Hospital LOS not affected (MD: −0.05 [−1.49 to 1.39]; p = 0.95)
- I2 = 0%
Postoperative complications
- All postoperative complications not affected
Safety
All postoperative complications
- Not affected
Original publication
Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. J Cardiothorac Vasc Anesth. Published 9 August 2023. doi:10.
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