Mortality and adverse events of extracorporeal haemoadsorption therapy in cardiac surgery: a systematic review and meta-analysis of randomised controlled trials.

Abstract

Extracorporeal haemoadsorption (HA) therapy has been studied in RCTs for use during cardiopulmonary bypass (CPB). CPB is known to activate a systemic inflammatory response. Haemoadsorption has the potential to mitigate this through the removal of pro-inflammatory mediators. We aimed to examine available RCT data reporting on clinically important outcomes in a systematic review and meta-analysis. We performed a systematic review and meta-analysis involving adult patients undergoing cardiac surgery with the use of CPB. The intervention was HA inserted into the CPB circuit, and the comparator was conventional CPB without HA. The primary outcome was mortality, and secondary outcomes included adverse events, requirements for organ support, and length of stay in ICU and hospitals. We included 12 RCTs with 713 participants. Only one study had low risk of bias, limiting the strength of findings. Meta-analysis showed no statistically significant benefit of HA during CPB on mortality (odds in the intervention vs control group (odds ratio, 95% confidence interval [CI]=1.08, 0.59-2.01, P=0.75), hospital length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=0.21, -1.89-2.30, P=0.82) and intensive care length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=-0.36, -1.31-0.60, P=0.42) when compared with standard CPB. However, confidence intervals included the possibility of clinically important benefit or harm. There was also no significant difference in adverse events or requirements for ventilation, cardiovascular support or renal replacement therapy. This meta-analysis did not show evidence of clinical benefit for routine use of HA during CPB for cardiac surgery, although clinically relevant benefit or harm cannot be excluded on the currently available evidence. Appropriately powered and clinically focused RCTs targeting cases at the highest risk of cytokine burden are required.