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Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA.

Meybohm P, Choorapoikayil S, Wessels A, Herrmann E, Zacharowski K, Spahn DR - Medicine (Baltimore) (2016)

Bottom Line: Data were pooled using a random effects model.The primary endpoint was the number of patients exposed to allogeneic red blood cell (RBC) transfusion.Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt bInstitute for Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland cInstitute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Germany.

ABSTRACT

Background: Cell salvage is commonly used as part of a blood conservation strategy. However concerns among clinicians exist about the efficacy of transfusion of washed cell salvage.

Methods: We performed a meta-analysis of randomized controlled trials in which patients, scheduled for all types of surgery, were randomized to washed cell salvage or to a control group with no cell salvage. Data were independently extracted, risk ratio (RR), and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random effects model. The primary endpoint was the number of patients exposed to allogeneic red blood cell (RBC) transfusion.

Results: Out of 1140 search results, a total of 47 trials were included. Overall, the use of washed cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average saving of 0.20 units of allogeneic RBC per patient (weighted mean differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11; P < 0.001), but did not significantly affect risk of mortality (RR = 0.92; 95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be observed in the number of patients exposed to re-operation, plasma, platelets, or rate of myocardial infarction and stroke.

Conclusions: Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.

No MeSH data available.


Related in: MedlinePlus

Forest plot of cell saver compared with no cell saver in cardiac surgery. (A) Number of patients exposed to allogeneic RBC, (B) number of units of allogeneic RBC per patient, (C) infections, (D) mortality rate. RBC = red blood cell.
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Figure 4: Forest plot of cell saver compared with no cell saver in cardiac surgery. (A) Number of patients exposed to allogeneic RBC, (B) number of units of allogeneic RBC per patient, (C) infections, (D) mortality rate. RBC = red blood cell.

Mentions: We found 21 studies[9,14–16,20,22,23,28,29,32,33,35–37,41,43,46,47,50,51,53] with a total of 2249 patients undergoing cardiac surgery. Sixteen trials[14–16,20,22,23,28,32,33,36,41,43,46,50,53,54] including 1056 patients in the cell salvage group and 867 control patients showed an overall reduced exposure to allogeneic blood cells by a relative 29% (RR = 0.71; 95% CI 0.62 to 0.81; P < 0.001) (Fig. 4A). Analysis of 17 trials[9,14–16,20,22,23,28,32,35–37,41,46,50,51,53] involving 1109 patients assigned to the cell salvage group and 908 control patients revealed an average saving of 0.65 units per patient (RR = −0.65; 95% CI −0.69 to −0.62; P < 0.001) (Fig. 4B). The use of cell salvage did neither affect infection (RR = 0.94; 95% CI 0.61 to 1.46; P = 0.79) nor mortality rate (RR = 0.72; 95% CI 0.37 to 1.39; P = 0.32) (Fig. 4C, D).


Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA.

Meybohm P, Choorapoikayil S, Wessels A, Herrmann E, Zacharowski K, Spahn DR - Medicine (Baltimore) (2016)

Forest plot of cell saver compared with no cell saver in cardiac surgery. (A) Number of patients exposed to allogeneic RBC, (B) number of units of allogeneic RBC per patient, (C) infections, (D) mortality rate. RBC = red blood cell.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979849&req=5

Figure 4: Forest plot of cell saver compared with no cell saver in cardiac surgery. (A) Number of patients exposed to allogeneic RBC, (B) number of units of allogeneic RBC per patient, (C) infections, (D) mortality rate. RBC = red blood cell.
Mentions: We found 21 studies[9,14–16,20,22,23,28,29,32,33,35–37,41,43,46,47,50,51,53] with a total of 2249 patients undergoing cardiac surgery. Sixteen trials[14–16,20,22,23,28,32,33,36,41,43,46,50,53,54] including 1056 patients in the cell salvage group and 867 control patients showed an overall reduced exposure to allogeneic blood cells by a relative 29% (RR = 0.71; 95% CI 0.62 to 0.81; P < 0.001) (Fig. 4A). Analysis of 17 trials[9,14–16,20,22,23,28,32,35–37,41,46,50,51,53] involving 1109 patients assigned to the cell salvage group and 908 control patients revealed an average saving of 0.65 units per patient (RR = −0.65; 95% CI −0.69 to −0.62; P < 0.001) (Fig. 4B). The use of cell salvage did neither affect infection (RR = 0.94; 95% CI 0.61 to 1.46; P = 0.79) nor mortality rate (RR = 0.72; 95% CI 0.37 to 1.39; P = 0.32) (Fig. 4C, D).

Bottom Line: Data were pooled using a random effects model.The primary endpoint was the number of patients exposed to allogeneic red blood cell (RBC) transfusion.Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt bInstitute for Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland cInstitute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Germany.

ABSTRACT

Background: Cell salvage is commonly used as part of a blood conservation strategy. However concerns among clinicians exist about the efficacy of transfusion of washed cell salvage.

Methods: We performed a meta-analysis of randomized controlled trials in which patients, scheduled for all types of surgery, were randomized to washed cell salvage or to a control group with no cell salvage. Data were independently extracted, risk ratio (RR), and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random effects model. The primary endpoint was the number of patients exposed to allogeneic red blood cell (RBC) transfusion.

Results: Out of 1140 search results, a total of 47 trials were included. Overall, the use of washed cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average saving of 0.20 units of allogeneic RBC per patient (weighted mean differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11; P < 0.001), but did not significantly affect risk of mortality (RR = 0.92; 95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be observed in the number of patients exposed to re-operation, plasma, platelets, or rate of myocardial infarction and stroke.

Conclusions: Washed cell salvage is efficacious in reducing the need for allogeneic RBC transfusion and risk of infection in surgery.

No MeSH data available.


Related in: MedlinePlus