Evidence map›Paper›PMID 30107514›Full record

SynthesisEuropean heart journal2019

Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis.

Nadine Shehata, Nikhil Mistry, Bruno R da Costa, Tiago V Pereira, Richard Whitlock, Gerard F Curley, David A Scott, Gregory M T Hare, Peter Jüni, C David Mazer

Abstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021
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  10. 2024 EACTS/EACTAIC Guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Nadine ShehataDivision of Hematology, Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada.
Nikhil MistryDepartment of Anesthesia, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.
Bruno R da CostaApplied Health Research Center (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, 30 Bond Street, Toronto, ON, Canada.
Tiago V PereiraApplied Health Research Center (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, 30 Bond Street, Toronto, ON, Canada.
Richard WhitlockDepartment of Surgery, Population Health Research Institute, McMaster University, David Braley Cardiac Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, Canada.
Gerard F CurleyDepartment of Anesthesia and Critical Care, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
David A ScottDepartment of Anesthesia and Acute Pain Medicine, St Vincent's Hospital, University of Melbourne, 41 Victoria Parade, Fitzroy, Victoria, Australia.
Gregory M T HareDepartments of Anesthesia and Physiology and Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.
Peter JüniDepartment of Medicine and Institute of Health Policy, Management and Evaluation, Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada.
C David MazerDepartments of Anesthesia and Physiology and Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo determine whether a restrictive strategy of red blood cell (RBC) transfusion at lower haemoglobin concentrations is inferior to a liberal strategy of RBC transfusion at higher haemoglobin concentrations in patients undergoing cardiac surgery. METHODS AND

resultsWe conducted a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials of the effect of restrictive and liberal RBC transfusion strategies on mortality within 30 days of surgery as the primary outcome. Secondary outcomes were those potentially resulting from anaemia-induced tissue hypoxia and transfusion outcomes. We searched the electronic databases MEDLINE, EMBASE, and the Cochrane Library until 17 November 2017. Thirteen trials were included. The risk ratio (RR) of mortality derived from 4545 patients assigned to a restrictive strategy when compared with 4547 transfused according to a liberal strategy was 0.96 [95% confidence interval (CI) 0.76-1.21, I2 = 0]. A restrictive strategy did not have a statistically significant effect on the risk of myocardial infarction (RR 1.01, 95% CI 0.81-1.26; I2=0), stroke (RR 0.93, 95% CI 0.68-1.27, I2 = 0), renal failure (RR 0.96, 95% CI 0.76-1.20, I2 = 0), or infection (RR 1.12, 95% CI 0.98-1.29, I2 = 0). Subgroup analysis of adult and paediatric trials did not show a significant interaction. At approximately 70% of the critical information size, the meta-analysis of mortality crossed the futility boundary for inferiority of the restrictive strategy.

conclusionThe current evidence does not support the notion that restrictive RBC transfusion strategies are inferior to liberal RBC strategies in patients undergoing cardiac surgery.

Indexed as

AdultAnemiaCardiac Surgical ProceduresChildErythrocyte TransfusionHemoglobinsHumansHypoxiaInfectionsMyocardial InfarctionOdds RatioRandomized Controlled Trials as TopicRenal InsufficiencyStrokeHemoglobinsBlood transfusionCardiac surgeryThresholds

Identifiers

PMID30107514
PMCPMC6441852

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.