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Abstract
Objectives Goal-directed optimisation of cerebral oxygenation using near-infrared spectroscopy (NIRS) during cardiopulmonary bypass is widely used. We tested the hypotheses that the use of NIRS cerebral oximetry results in reductions in cerebral injury (neurocognitive function, serum biomarkers), injury to other organs including the heart and brain, transfusion rates, mortality and resource use.
Design Systematic review and meta-analysis.
Setting Tertiary cardiac surgery centres in North America, Europe and Asia.
Participants A search of Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature Plus from inception to November 2016 identified 10 randomised trials, enrolling a total of 1466 patients, all in adult cardiac surgery.
Interventions NIRS-based algorithms designed to optimise cerebral oxygenation versus standard care (non-NIRS-based) protocols in cardiac surgery patients during cardiopulmonary bypass.
Outcome measures Mortality, organ injury affecting the brain, heart and kidneys, red cell transfusion and resource use.
Results Two of the 10 trials identified in the literature search were considered at low risk of bias. Random-effects meta-analysis demonstrated similar mortality (risk ratio (RR) 0.76, 95% CI 0.30 to 1.96), major morbidity including stroke (RR 1. 08, 95% CI 0.40 to 2.91), red cell transfusion and resource use in NIRS-treated patients and controls, with little or no heterogeneity. Grades of Recommendation, Assessment, Development and Evaluation of the quality of the evidence was low or very low for all of the outcomes assessed.
Conclusions The results of this systematic review did not support the hypotheses that cerebral NIRS-based algorithms have clinical benefits in cardiac surgery.
Trial registration number PROSPERO CRD42015027696.
- cardiopulmonary bypass
- cerebral oxygenation
- near Infra-red spectroscopy
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Footnotes
Contributors Both of the study authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. GJM conceived and designed the study, and undertook the systematic review. GFS wrote the protocol, undertook the systematic review, performed the analysis and drafted the report along with GJM. Both authors reviewed the report for important intellectual content and approved the final version.
Funding This work was supported by the National Institute for Health Research Programme Grants for Applied Health number RP-PG-0407-10384. GFS is supported by the Leicester NIHR Cardiovascular Biomedical Research Unit. GJM is supported by British Heart Foundation Grants RG/13/6/29947 and CH/12/1/29419.
Competing interests GFS declares no conflict of interest. GJM reports grants from British Heart Foundation during the conduct of the study and grants from British Heart Foundation, grants from National Institute for Health Research, grants from Zimmer Biomet, personal fees from AbbVie, and personal fees from Thrasos, outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.