Department of Anesthesiology and Intensive Care, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Jl. Kesehatan No. 1, Sendowo, Sekip Utara, Depok District, Sleman Regency, Yogyakarta, 55281, Indonesia.
Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
J Cardiothorac Surg. 2023 Oct 13;18(1):291. doi: 10.1186/s13019-023-02406-y.
The use of cardiopulmonary bypass (CPB) is almost inevitable in cardiac surgery. However, it can cause complications, including hemolysis. Until now, there have not been any standards for reducing hemolysis from CPB. Therefore, this systematic review was conducted to determine the factors that increase or reduce hemolysis in the use of CPB.
Keywords Earches (cardiac surgery AND cardiopulmonary bypass AND hemolysis) were done on PubMed databases and Cochrane CENTRAL from 1990-2021 for published randomized controlled trials (RCTs) that studied interventions on CPB, in cardiac surgery patients, and measured hemolysis as one of the outcomes. Studies involving patients with preoperative hematological disorders, prosthetic valves, preoperative use of intra-aortic balloon pumps and extracorporeal circulation, emergency and minimally invasive surgery are excluded RESULTS: The search yielded 64 studies that met the inclusion criteria, which involved a total of 3,434 patients. The most common surgery was coronary revascularization (75%). Out of 64 studies, 33 divided into 7 analyses. Remaining 31 studies were synthesized qualitatively. Significant decreases were found in centrifugal vs roller pumps for PFHb (p = 0.0006) and Hp (p < 0.0001) outcomes, separated vs combined suctioned blood (p = 0.003), CPB alternatives vs conventional CPB (p < 0.0001), and mini extracorporeal circulation (MiniECC) vs conventional CPB for LDH (p = 0.0008). Significant increases were found in pulsatility (p = 0.03) and vacuum-assisted venous drainage (VAVD) vs gravity-assisted venous drainage (GAVD) (p = 0.002).
The review shows that hemolysis could be caused by several factors and efforts have been made to reduce it, combining significant efforts could be beneficial. However, this review has limitations, such as heterogeneity due to no standards available for conducting CPB. Therefore, further research with standardized guidelines for CPB is needed to yield more comparable studies. Meta-analyses with more specific parameters should be done to minimize heterogeneity.
体外循环（CPB）在心脏手术中几乎是不可避免的。然而，它会引起并发症，包括溶血。到目前为止，还没有任何降低 CPB 溶血的标准。因此，本系统评价旨在确定增加或减少 CPB 中溶血的因素。
在 PubMed 数据库和 Cochrane CENTRAL 中使用关键词“心脏手术 AND 体外循环 AND 溶血”进行搜索，检索时间从 1990 年至 2021 年，纳入研究 CPB 干预措施的已发表随机对照试验（RCT），这些研究对象为心脏手术患者，且将溶血作为其中一项结局进行测量。排除术前存在血液学疾病、人工瓣膜、术前使用主动脉内球囊泵和体外循环、急诊和微创手术的患者。
搜索共获得 64 项符合纳入标准的研究，共涉及 3434 例患者。最常见的手术是冠状动脉血运重建（75%）。64 项研究中，有 33 项分为 7 个分析。其余 31 项研究进行了定性综合分析。与滚压泵相比，离心泵对 PFHb（p=0.0006）和 Hp（p<0.0001）的降低作用更明显，单独吸引与联合吸引血液（p=0.003）、CPB 替代物与传统 CPB（p<0.0001）、迷你体外循环（MiniECC）与传统 CPB 相比，乳酸脱氢酶（LDH）的降低作用更明显（p=0.0008）。脉动（p=0.03）和真空辅助静脉引流（VAVD）与重力辅助静脉引流（GAVD）相比（p=0.002）溶血作用增加。
该评价表明，溶血可能由多种因素引起，已经采取了降低溶血的措施，综合起来可能会有益处。但是，由于没有 CPB 操作的标准，本评价存在局限性。因此，需要进一步研究标准化的 CPB 指南，以产生更具可比性的研究。应该进行具有更具体参数的荟萃分析，以最小化异质性。
