Intraoperative hemoadsorption and postoperative inflammatory biomarkers in patients undergoing cardiac surgery, a meta-analysis of randomized controlled trials

Abstract

Abstract Aim We aimed to perform a meta-analysis to evaluate the effect of intraoperative hemoadsorption (HA) with cardiopulmonary bypass (CPB) on postoperative inflammatory biomarkers in patients undergoing cardiac surgery. Methods We searched PubMed, Web of Science, and Scopus databases for randomized controlled trials (RCTs) that compared intraoperative HA with CPB versus CPB without intraoperative HA in patients undergoing cardiac surgery in terms of postoperative inflammatory biomarkers. Results Twelve RCTs involving 830 patients (420 in HA group and 410 control group) were included. HA was associated with significantly lower interleukin-6 (IL-6) levels at 6 h (SMD = − 3.33, 95% CI − 6.55 to − 0.11; p = 0.04). However, no significant differences were observed in IL-6 at end of CPB, 24 h, or 48 h. Tumor necrosis factor-α (TNF-α) levels did not differ significantly between groups at end of CPB (SMD = − 0.29, 95% CI − 0.77 to 0.20; p = 0.25), 6 h (SMD = − 0.22, 95% CI − 0.55 to 0.12; p = 0.21), 24 h (SMD = − 0.22, 95% CI − 0.53 to 0.10; p = 0.17), or 48 h (SMD = 0.02, 95% CI − 0.29 to 0.34; p = 0.89). Similarly, no significant between-group differences were found in interleukin-8, interleukin-10, C-reactive protein, procalcitonin, or leukocyte counts at the assessed postoperative time points. Conclusion Our study shows that intraoperative HA in cardiac surgery has no clear evidence of reducing the postoperative inflammatory response. Further clinical research, particularly large-scale clinical trials with more standardized management protocols, is required to guide further use of HA in cardiac surgery.