Impact of cell saver during cardiac surgery on blood transfusion requirements: a systematic review and meta-analysis

Objective We performed a systematic review and meta-analysis of randomized clinical trials on adult patients undergoing cardiac surgery and compared the rates of red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusion between the cell saver (CS) and the standard of care groups. Methods MEDLINE (R), The Cochrane Central Register of Controlled Trials (CENTRAL), American Society of Hematology (ASH) and bibliographies of relevant studies were searched. We used random-effect model. Results Our search strategy returned 624 citations, of which 15 studies were selected. The use of CS did not decrease the rate of RBC transfusion (odds ratio [OR]: 0 center dot 69; 95% CI: 0 center dot 48-1 center dot 00), albeit with a substantial heterogeneity (I-2 = 60%). The year of publication explained most of the heterogeneity (P for subgroup effect <0 center dot 001). Although the rate of platelet transfusion was lower in the CS group, the difference was not statistically significant (OR: 0 center dot 83; 95% CI: 0 center dot 57-1 center dot 2; I-2 = 0%). The rate of FFP transfusion was numerically higher in the CS group; however, this difference did not reach statistical significance (OR: 1 center dot 26; 95% CI: 0 center dot 82-1 center dot 94; I-2 = 15%). Only two studies scored five on the Jadad score. There was no indication of a publication bias using the funnel plot and Egger test (P = 0 center dot 34, 0 center dot 87, and 0 center dot 62 for RBC, platelet and FFP, respectively). Conclusion The use of CS during cardiac surgery does not have an impact on the rates of RBC, platelet and FFP transfusion; however, this should be interpreted in the light of the study limitations.