Summary of findings 2. Cell salvage compared to no cell salvage in cardiovascular (vascular) surgeries.
| Cell salvage compared to no cell salvage in cardiovascular (vascular) surgeries | ||||||
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Patient or population: cardiovascular (vascular) surgeries Setting: hospital Intervention: cell salvage Comparison: no cell salvage | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no cell salvage | Risk with cell salvage | |||||
| Transfusions (during hospital stay) | 704 per 1000 | 429 per 1000 (225 to 809) | RR 0.61 (0.32 to 1.15) | 266 (4 RCTs) | ⨁◯◯◯ Very lowa,b,c | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on allogeneic transfusion risk |
| Volume of transfusion (units) (PPT) (during hospital stay) | The mean volume of transfusion (units) (PPT) ranged from 1.5 to 3.19 units | MD 0.05 higher (0.64 lower to 0.74 higher) | ‐ | 74 (2 RCTs) | ⨁⨁◯◯ Lowd,e | There may be no difference between cell salvage use and no cell salvage use for the volume of transfusion required PPT |
| Mortality (up to 90 days) | 31 per 1000 | 36 per 1000 (12 to 104) | POR 1.19 (0.39 to 3.65)f | 384 (6 RCTs) | ⨁◯◯◯ Very lowa,g | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on mortality risk |
| DVT (up to 90 days) | 0 per 1000 | 0 per 1000 (0 to 0) | RD 0.00 (‐0.04 to 0.04) | 100 (1 RCT) | ⨁◯◯◯ Very lowa,h | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on DVT risk |
| Infection (up to 90 days) | 66 per 1000 | 15 per 1000 (2 to 130) | RR 0.23 (0.03 to 1.98) | 117 (2 RCTs) | ⨁◯◯◯ Very lowa,i | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on infection risk |
| MI (up to 90 days) | 39 per 1000 | 30 per 1000 (7 to 122) | POR 0.76 (0.17 to 3.41)f | 203 (3 RCTs) | ⨁◯◯◯ Very lowa,i | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on MI risk |
| CVA (stroke) (up to 90 days) | 20 per 1000 | 3 per 1000 (0 to 122) | POR 0.14 (0.00 to 6.82)f | 100 (1 RCT) | ⨁◯◯◯ Very lowa,g | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on CVA risk |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CVA: cerebrovascular accident; DVT: deep vein thrombosis; MD: mean difference; MI: myocardial infarction; MID: minimally important difference; OIS: optimal information size; POR: Peto odds ratio; PPT: per person transfused; RD: risk difference; ROB: risk of bias; RR: risk ratio; SD: standard deviation | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded once for ROB due to judgement of unclear and low risk in the majority of domains (mostly unclear) bDowngraded twice for inconsistency: I2 = 82%, high heterogeneity cDowngraded once for imprecision: confidence interval crosses one boundary for minimally important difference (MID: 0.8 to 1.25) dDowngraded twice for ROB due to judgement of majority at unclear risk, but with 3 high risk domains in one study which contributed 33% of the weight eMID calculated as +/‐ 0.5*SD in control group = +/‐ 0.5*1.61 fPeto OR used due to low event rate in both groups (< 5%) gDowngraded three times for imprecision: very wide confidence intervals (crosses both boundaries for MID: 0.8 to 1.25) and far below OIS for this outcome hDowngraded twice for imprecision: sample size far below OIS required for this outcome (rare events) iDowngraded twice for imprecision: confidence interval crosses both boundaries for MID (0.8 to 1.25)