(P178) CONTINUOUS FORMS OF INTRA-OPERATIVE ULTRAFILTRATION ENHANCE RECOVERY AFTER ADULT CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background:

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with complement-mediated systemic inflammation, endothelial leak syndrome and cardiopulmonary dysfunction, which can prolong post-operative recovery. Ultrafiltration has been used during cardiac surgery to extract pro-inflammatory mediators, prevent volume overload and hemoconcentrate both coagulation factors and circulating hematologic cells. Continuous forms of ultrafiltration, which are used throughout the entire CPB time, could potentially maximize the many therapeutic effects of this technique. This systematic review and meta-analysis of randomized controlled trials aims to investigate if continuous ultrafiltration enhances clinical outcomes and recovery after adult cardiac surgery with CPB.

METHODS AND RESULTS: We performed a pre-specified systematic review and meta-analysis (PROSPERO: CRD42020219309) and reported the results following PRISMA guidelines. MEDLINE, Embase, CENTRAL and Scopus were systematically searched on November 3, 2021. Randomized controlled trials investigating continuous forms of ultrafiltration during adult cardiac surgery were identified and included. Each study was assessed for risk of bias using the Cochrane RoB2 instrument. The primary endpoint was operative mortality, and secondary outcomes included Intensive Care Unit Length of Stay (ICU LOS), Ventilation Time, Acute Kidney Injury (AKI) or Renal Failure and Pneumonia. All outcomes were analyzed with an inverse-variance random-effects model and assessed for GRADE Quality of Evidence.

Results: Twelve single centre randomized controlled trials consisting of 989 adult patients undergoing coronary, valvular or concomitant cardiac procedures were included. Compared to controls, patients receiving continuous ultrafiltration had a substantial but imprecise reduction of operative mortality (risk ratio = 0.32; 95% CI: 0.10 – 1.03; p=0.06; number needed to treat=30 ), reduction in ICU LOS of 7.01 hours (95% CI: 1.86 – 12.15; p=0.008), reduction in Ventilation Time of 2.11 hours (95% CI: 0.71 – 3.51; p=0.003), and a reduction of post-operative Pneumonia (risk ratio = 0.33; 95% CI: 0.15 – 0.75; p=0.008; number needed to treat =15). There was no difference in rates of AKI or Renal Failure between ultrafiltration and control groups (risk ratio = 0.84; 95% CI: 0.48 – 1.48; p=0.55). The GRADE Quality of Evidence for these outcomes ranged from very low to low.

Conclusion:

Conclusion: Continuous forms of ultrafiltration reduced ICU LOS, Ventilation Time, the risk of post-operative Pneumonia and suggested a potential reduction in operative mortality for adults undergoing cardiac surgery with CPB. These results present equipoise for a well-powered multi-center randomized controlled trial to confirm the efficacy and generalizability of continuous ultrafiltration to enhance recovery after adult cardiac surgery.