Systematic Review of Transfusion Strategies for Cardiac Surgery_Journal of Biomedical Engineering

Authors：

WUQinjuan , ZHOURonghua ,  LIUBin

Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIUBin, Email: benbinliu@hotmail.com

Keywords：

cardiac surgery; restrictive transfusion; liberal transfusion; Meta-analyses; systematic review

DOI：

10.7507/1001-5515.20140060

Video：

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This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed,MEDLINE,Cochrane Library (Issue10,2012),from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD=-1.46,95% CI -1.18--1.1) and the volume of RBCs transfusion (RR=0.69,95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality,adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.

Citation： WUQinjuan, ZHOURonghua, LIUBin. Systematic Review of Transfusion Strategies for Cardiac Surgery. Journal of Biomedical Engineering, 2014, 31(2): 319-326. doi: 10.7507/1001-5515.20140060 Copy

1.	SQUIRES,J E.Risks of transfusion[J].South Med J,2011,104(11):762-769.
2.	GRESENS C J,HOLLAND P V.Current risks of viral hepatitis from blood transfusions[J].J Gastroenterol Hepatol,1998,13(4):443-449.
3.	GILLISS B M,LOONEY M R,GROPPER M A.Reducing noninfectious risks of blood transfusion[J].Anesthesiol,2011,115(3):635-649.
4.	MURPHY G J,REEVES B C,ROGERS C A,et al.Increased mortality,postoperative morbidity,and cost after red blood cell transfusion in patients having cardiac surgery[J].Circulation,2007,116(22):2544-2552.
5.	CARSON J L,CARLESS P A,HEBERT P C.Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion[J].Cochrane Database Syst Rev,2012,4:CD002042.
6.	HAJJAR L A,VINCENT J L,GALAS F R,et al.Transfusion requirements after cardiac surgery:the TRACS randomized controlled trial[J].JAMA,2010,304(14):1559-1567.
7.	BRACEY A W,RADOVANCEVIC R,RIGGS S A.Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures:effect on patient outcome[J].Transfusion,1999,39(10):1070-1077.
8.	JOHNSON R G,THURER R L,KRUSKALL M S,et al.Comparison of two transfusion strategies after elective operations for myocardial revascularization[J].J Thorac Cardiovasc Surg,1992,104(2):307-314.
9.	SHEHATA N.BURNS L A.NATHAN H,et al.A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery[J].Transfusion,2012,52(1):91-99.
10.	CHOLETTE J M,RUBENSTEIN J S,ALFIERIS G M.Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection:results of a prospective,randomized,controlled trial of a restrictive versus liberal red-cell transfusion strategy[J].Pediatr Crit Care Med 2011,12(1):39-45.
11.	WILLEMS A.HARRINGTON K.LACROIX J,et al.Comparison of two red-cell transfusion strategies after pediatric cardiac surgery:a subgroup analysis[J].Crit Care Med,2010,38(2):649-656.
12.	HEBERT P C.WELLS G.BLAJCHMAN M A,et al.A multicenter,randomized,controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators,Canadian Critical Care Trials Group[J].N Eng J Med,1999,340(6):409-417.
13.	KOCH C G,LI L,DUNCAN A I,et al.Morbidity and mortality risk associated with erythrocytes and blood-component transfusion in isolated coronary artery bypass grafting[J].Crit Care Med,2006,340(6):1608-1616.
14.	HUBER-WAGNER S,QVICK M,MUSSACK T,et al.Massive blood transfusion and outcome in 1062 poly trauma patients:a prospective study based on the Trauma Registry of the German Trauma Society[J].Vox Sang,2007,92(1):69-78.
15.	SURGENOR S D,KRAMER R S,OLMSTEAD E M,et al.Transfusion and descreased long-term survival after cardic surgery[J].Anesth Analg,2009,108(6):1741-1746.
16.	NIELSEN H J,REIMERT C M,PEDERSEN A N,et al.Time dependent,spontaneous release of white cell and platelet-derived bioactice substances from stored human blood[J].Transfusion,1996,36(11-12):960-965.
17.	JENSEN L S.Benefits of leukocyte-reduced blood transfusion in surgical patients[J].Transfusion,1998,5(6):376-380.

1. SQUIRES,J E.Risks of transfusion[J].South Med J,2011,104(11):762-769.
2. GRESENS C J,HOLLAND P V.Current risks of viral hepatitis from blood transfusions[J].J Gastroenterol Hepatol,1998,13(4):443-449.
3. GILLISS B M,LOONEY M R,GROPPER M A.Reducing noninfectious risks of blood transfusion[J].Anesthesiol,2011,115(3):635-649.
4. MURPHY G J,REEVES B C,ROGERS C A,et al.Increased mortality,postoperative morbidity,and cost after red blood cell transfusion in patients having cardiac surgery[J].Circulation,2007,116(22):2544-2552.
5. CARSON J L,CARLESS P A,HEBERT P C.Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion[J].Cochrane Database Syst Rev,2012,4:CD002042.
6. HAJJAR L A,VINCENT J L,GALAS F R,et al.Transfusion requirements after cardiac surgery:the TRACS randomized controlled trial[J].JAMA,2010,304(14):1559-1567.
7. BRACEY A W,RADOVANCEVIC R,RIGGS S A.Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures:effect on patient outcome[J].Transfusion,1999,39(10):1070-1077.
8. JOHNSON R G,THURER R L,KRUSKALL M S,et al.Comparison of two transfusion strategies after elective operations for myocardial revascularization[J].J Thorac Cardiovasc Surg,1992,104(2):307-314.
9. SHEHATA N.BURNS L A.NATHAN H,et al.A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery[J].Transfusion,2012,52(1):91-99.
10. CHOLETTE J M,RUBENSTEIN J S,ALFIERIS G M.Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection:results of a prospective,randomized,controlled trial of a restrictive versus liberal red-cell transfusion strategy[J].Pediatr Crit Care Med 2011,12(1):39-45.
11. WILLEMS A.HARRINGTON K.LACROIX J,et al.Comparison of two red-cell transfusion strategies after pediatric cardiac surgery:a subgroup analysis[J].Crit Care Med,2010,38(2):649-656.
12. HEBERT P C.WELLS G.BLAJCHMAN M A,et al.A multicenter,randomized,controlled clinical trial of transfusion requirements in critical care.Transfusion Requirements in Critical Care Investigators,Canadian Critical Care Trials Group[J].N Eng J Med,1999,340(6):409-417.
13. KOCH C G,LI L,DUNCAN A I,et al.Morbidity and mortality risk associated with erythrocytes and blood-component transfusion in isolated coronary artery bypass grafting[J].Crit Care Med,2006,340(6):1608-1616.
14. HUBER-WAGNER S,QVICK M,MUSSACK T,et al.Massive blood transfusion and outcome in 1062 poly trauma patients:a prospective study based on the Trauma Registry of the German Trauma Society[J].Vox Sang,2007,92(1):69-78.
15. SURGENOR S D,KRAMER R S,OLMSTEAD E M,et al.Transfusion and descreased long-term survival after cardic surgery[J].Anesth Analg,2009,108(6):1741-1746.
16. NIELSEN H J,REIMERT C M,PEDERSEN A N,et al.Time dependent,spontaneous release of white cell and platelet-derived bioactice substances from stored human blood[J].Transfusion,1996,36(11-12):960-965.
17. JENSEN L S.Benefits of leukocyte-reduced blood transfusion in surgical patients[J].Transfusion,1998,5(6):376-380.

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