Benefícios da autotransfusão intraoperatória para pacientes submetidos a cirurgias cardíacas: uma revisão sistemática

Abstract

Objective: Systematic review the efficacy and safety of intraoper-ative cell savage systems during cardiac surgeries. Method: An overview of literature was conducted. MEDLINE, The Cochrane Library, LILACS and CRD databases were searched for systematic reviews that compared cell savage systems with standard-of-care in patients undergoing cardiac surgeries. No date, language or location restrictions were applied. Methodological quali-ty was assessed according to the AMSTAR checklist. Results: Five studies were included in the final analysis. No significant benefit with the use of cell savage systems has been shown in terms of final outcomes (e. g. death, infarction, stroke, reoperation for bleeding, infections) in cardiac patients, despite reasonable sample sizes. There was also no significant difference in the risk of exposure or volume transfused of fresh frozen plasma or platelets. Most studies consider cell savage effective in reducing the risk of red blood cell transfusion. However, the most recent meta-analysis observed that this effect is determined by older studies. When a subgroup analysis that con-sidered the date of publication was performed, the aggregated results of re-cent studies no longer demonstrate this effect. The quality of the systematic reviews was considered reasonable. Conclusion: The benefits of cell savage in terms of final outcomes, or even intermediate outcomes, have not been demonstrated. Therefore, a recommendation for its incorporation in cardiac surgeries is not reasonable. There is, however, the need of an updated sys-tematic review that includes all relevant evidence and subgroup analyzes on the matter.