Ultrafiltration in cardiac surgery: Results of a systematic review and meta-analysis

Hensley, Nadia B.; Colao, Joseph; Zorrilla‐Vaca, Andrés; Nanavati, Julie; Lawton, Jennifer S.; Raphael, Jacob; Mazzeffi, Michael; Wierschke, Chad; Kostibas, Megan P.; Cho, Brian; Frank, Steven M.; Grant, Michael C.

doi:10.1177/02676591231157970

Cited by 6 publications

(2 citation statements)

References 30 publications

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“…Due to the nature of surgery, 10% 15% of the US blood supply is allocated for cardiac surgical patients with approximately 40% to 60% of patients receiving an allogeneic transfusion during hospitalization. 22,23 Blood conservation practices in cardiac and other surgeries include (1) preoperative anemia management, (2) retrograde autologous priming, 24 (3) acute normovolemic hemodilution, (4) antifibrinolytics, (5) restrictive hemoglobin transfusion triggers, (6) viscoelastic testing transfusion algorithms, (7) modified ultrafiltration on bypass, 25 (8) cell salvage, and (9) hemostatic sealants. These strategies aim to prevent unnecessary transfusions and prevent coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Choi,

Nicholson,

Frank

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Perioperative red blood cell (RBC) transfusions increase venous thromboembolic (VTE) events. Although a previous study found that plasma resuscitation after trauma was associated with increased VTE, the risk associated with additional perioperative plasma is unknown. METHODS: A US claims and EHR database (TriNetX Diamond Network) was queried. We compared surgical patients who received perioperative plasma and RBC to patients who received perioperative RBC but not plasma. Subanalyses included (1) all surgeries (n = 48,580) and (2) cardiovascular surgeries (n = 38,918). Propensity score matching was performed for age at surgery, ethnicity, race, sex, overweight and obesity, type 2 diabetes, disorders of lipoprotein metabolism, essential hypertension, neoplasms, nicotine dependence, coagulopathies, sepsis, chronic kidney disease, liver disease, nonsteroidal anti-inflammatory analgesics, platelet aggregation inhibitors, anticoagulants, hemoglobin level, outpatient service utilization, and inpatient services; surgery type was included for “all surgeries” analyses. Outcomes included 30-day mortality, postoperative VTE, pulmonary embolism (PE), and disseminated intravascular coagulation (DIC). RESULTS: After matching the surgical cohorts, compared to only RBC, plasma + RBC was associated with higher risk of postoperative mortality (4.52% vs 3.32%, risk ratio [RR]: 1.36 [95% confidence interval, 1.24–1.49]), VTE (3.92% vs 2.70%, RR: 1.36 [1.24–1.49]), PE (1.94% vs 1.33%, RR: 1.46 [1.26–1.68]), and DIC (0.96% vs 0.35%, RR: 2.75 [2.15–3.53]). Among perioperative cardiovascular patients, adding plasma to RBC transfusion was associated with similar increased risk. CONCLUSIONS: When compared with perioperative RBC transfusion, adding plasma was associated with increased 30-day postoperative mortality, VTE, PE, and DIC risk among surgical and cardiovascular surgical patients. Reducing unnecessary plasma transfusion should be a focus of patient blood management to improve overall value in health care.

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Section: Discussionmentioning

confidence: 99%

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Choi,

Nicholson,

Frank

et al. 2024

Anesthesia &Amp; Analgesia

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“…16 According to some research, using UF during CPB to remove extra fluid is not kidney protective and may even harm the kidneys if the fluid withdrawn is greater than what is required. 17 Recent evaluations have also cautioned us to avoid AKI by limiting UF in individuals with impaired renal function. 18 Luciani et al conducted a trial on the use of MUF on clinical outcomes after CPB, the authors reported mean postoperative hemoglobin level 11.1±1.6 g/dl in MUF versus 11.2±1.8 g/dl without MUF (p>0.05).…”

Section: Discussionmentioning

confidence: 99%

Modified Ultrafiltration and Acute Kidney Injury in Patients Undergoing Open Heart Surgery Using Cardiopulmonary Bypass

Azam¹,

Alshammary²,

Farooq³

et al. 2023

PJMHS

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Objective: To determine the incidence of acute kidney injury (AKI) in patients undergoing open heart surgery using cardiopulmonary bypass (CBP) with and without modified ultrafiltration (MUF). Materials and Methods: A total of 150 patients who underwent open heart surgery using CPB in our hospital from Jan-2022 to Dec-2022. In group A patients MUF was performed during the CPB and atleast 1000 ml of volume was removed using MUF. While in group B patients, no filtration was performed during CPB. In ICU all patients were followed till three days after surgery to determine the incidence of AKI. Results: Mean age was 53.4±10.9 years in MUF group versus 55.6±11.8 years in control group, p-value 0.23. Majority, 53 (70.7%) patients were male in MUF and 57 (76%) in control group, p-value 0.55. Mean CPB time was 101.6±45.2 mins in MUF and 96.5±39.1 mins in control group, p-value 0.46. Mean X-clamp time was 47.5±19.3 mins in MUF and 51.4±21.6 mins in control group, p-value 0.43. The incidence of AKI was comparable, with frequency rate of 3 (4.0%) in MUF group versus 1 (1.3%) in control group, p-value 0.31. Conclusion: In present study, the incidence of AKI in MUF and control group was almost similar. So according to the results of present study, the use of MUF has no role in preventing or aggravating AKI in patients undergoing CPB. Keywords: Acute kidney injury, cardiopulmonary bypass, modified ultrafiltration.

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Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery

Pérez-Fernández,

Ulsamer,

Cámara-Rosell

et al. 2024

JAMA

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ImportanceCardiac surgery–associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate/polyethyleneimine membrane during CPB.ObjectiveTo determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB.Design, Setting, and ParticipantsThis double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care.InterventionNonselective EBP device connected to the CPB circuit.Main Outcomes and MeasuresThe primary outcome was the rate of CSA-AKI in the 7 days after randomization.ResultsAmong 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P = .03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P = .01). No significant differences (P &gt; .05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (&lt;40%), and lower body mass index (&lt;30). No differences were observed between the groups in adverse events tracking.Conclusions and RelevanceThe use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT02518087

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Ultrafiltration in cardiac surgery: Results of a systematic review and meta-analysis

Cited by 6 publications

References 30 publications

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Modified Ultrafiltration and Acute Kidney Injury in Patients Undergoing Open Heart Surgery Using Cardiopulmonary Bypass

Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery

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