Summary of findings 3. Cell salvage compared to no cell salvage in cardiovascular (no bypass) surgeries.
| Cell salvage compared to no cell salvage in cardiovascular (no bypass) surgeries | ||||||
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Patient or population: cardiovascular (no bypass) 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) | 624 per 1000 | 511 per 1000 (430 to 605) | RR 0.82 (0.69 to 0.97) | 169 (3 RCTs) | ⨁⨁⨁◯ Moderatea | There is probably an impact from cell salvage in reducing the risk of requiring allogeneic transfusion |
| Volume of transfusion (units) (PPT) (during hospital stay) | The mean volume of transfusion (units) (PPT) ranged from 1.57 to 2.4 units | MD 0.13 higher (0.8 lower to 1.07 higher) | ‐ | 56 (2 RCTs) | ⨁⨁◯◯ Lowb,c | 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) | 19 per 1000 | 3 per 1000 (0 to 39) | POR 0.13 (0.01 to 2.07)d | 209 (4 RCTs) | ⨁◯◯◯ Very lowe | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on mortality risk |
| DVT (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| Infection (up to 90 days) | 18 per 1000 | 36 per 1000 (4 to 273) | POR 2.06 (0.21 to 20.61)d | 110 (2 RCTs) | ⨁◯◯◯ Very lowa,e | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on infection risk |
| MI (up to 90 days) | 17 per 1000 | 32 per 1000 (3 to 247) | POR 1.98 (0.20 to 19.32)d | 120 (2 RCTs) | ⨁◯◯◯ Very lowe,f | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on MI risk |
| CVA (stroke) (up to 90 days) | 13 per 1000 | 12 per 1000 (1 to 166) | POR 0.98 (0.06 to 15.72)d | 160 (3 RCTs) | ⨁◯◯◯ Very lowe,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 low and unclear risk in the majority of domains (mostly unclear) bDowngraded twice for ROB due to low and unclear risk in all domains, but with the study contributing most having some baseline imbalance (recent MI), which may impact volume transfused cMID calculated as +/‐0.5*SD in control group = +/‐0.5*3.79 dPeto OR used due to low event rate in both groups (< 5%) eDowngraded three times for imprecision due to very wide confidence intervals and sample size far below OIS for this outcome (rare event) fDowngraded once for inconsistency: I2 = 64%, moderate heterogeneity gDowngraded once for inconsistency: I2 = 51%, moderate heterogeneity