Abstract:

Introduction (background):

The inflammatory response suffered by patients undergoing cardiac surgery (CS) with cardiopulmonary bypass, leads to a higher morbidity and mortality in the postoperative period. Mitigation strategies, such as the perioperative utilization of zero-balanced ultrafiltration (Z-BUF), have been demonstrated to be effective for the removal of inflammatory mediators (IM). Nevertheless, its clinical impact remains uncertain. The aim of this review is to assess whether there is sufficient evidence to endorse the usage of perioperative Z-BUF for the enhancement of the different organic functions (OF) and postoperative clinical outcomes (PCO).

Material and methods:

A comprehensive literature search was conducted using the "Medline" and "Embase" databases via the search engines "PubMed" and "Google Scholar", focusing on articles published between 1991 and 2023, utilizing the Medical Subject Headings (MesH) "cardiopulmonary bypass", "ultrafiltration", and "hemofiltration". Case studies, clinical, observational, comparative, and randomized controlled studies, as well as meta-analyses and systematic reviews published in English, conducted on adult, pediatric patients and animal models were selected. Finally, from a total of 114 articles collected, 71 remained for the review.

Results:

Z-BUF presents potential advantages in CS, being effective for correcting hydroelectrolytic imbalances and eliminating IM. It also demonstrates a positive impact on pulmonary and renal function, though its influence on cardiac and neurological function remains unclear. While the benefits in terms of reducing blood loss, infections, mortality, and hospital length of stay (LoS) are not apparent, reductions in the duration of mechanical ventilation and intensive care unit LoS were observed.

Conclusion:

Z-BUF is a promising technique with the potential to positively impact on OF and PCO. However, the lack of consensus and the need for further rigorous evaluation, including prospective and randomized studies, underscore the imperative for continued research to solidify its clinical adoption.

References:

·       Kandil, Omneya A., et al. “Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta‐analysis.” Clinical Cardiology, vol. 44, no. 12, Nov. 2021, pp. 1700–08. https://doi.org/10.1002/clc.23750

·       García-Camacho, Carlos, et al. “Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial.” PloS One, vol. 15, no. 11, Nov. 2020, p. e0242411. https://doi.org/10.1371/journal.pone.0242411.

·       Dehaki, Maziar Gholampour, et al. “Zero‐balance ultrafiltration of the priming blood modifies the priming components and improves the clinical outcome in infants undergoing cardiopulmonary bypass: A randomized controlled trial.” Artificial Organs, vol. 44, no. 3, Sept. 2019, pp. 288–95. https://doi.org/10.1111/aor.13559.

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