Evidence map›Paper›PMID 32124256›Full record

SynthesisCanadian journal of anaesthesia = Journal canadien d'anesthesie2020

The effect of restrictive versus liberal transfusion strategies on longer-term outcomes after cardiac surgery: a systematic review and meta-analysis with trial sequential analysis.

Hessam H Kashani, Carly Lodewyks, Morvarid S Kavosh, Maya M Jeyaraman, Christine Neilson, George Okoli, Rasheda Rabbani, Ahmed M Abou-Setta, Ryan Zarychanski, Hilary P Grocott

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 36% of its field
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

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Perioperative Blood Management.Journal of clinical medicine · 2025
    Review
  3. Patient blood management in the ICU: A narrative review of the literature.European journal of anaesthesiology and intensive care · 2022
    Review
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 1 country.

Hessam H KashaniDepartment of Anesthesiology, Perioperative and Pain Medicine, St. Boniface Hospital, University of Manitoba, CR3008-369 Tache Ave, Winnipeg, MB, R2H 2A6, Canada.
Carly LodewyksSection of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
Morvarid S KavoshDepartment of Anesthesiology, Perioperative and Pain Medicine, St. Boniface Hospital, University of Manitoba, CR3008-369 Tache Ave, Winnipeg, MB, R2H 2A6, Canada.
Maya M JeyaramanThe George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Christine NeilsonNeil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada.
George OkoliThe George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Rasheda RabbaniThe George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Ahmed M Abou-SettaThe George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
Ryan ZarychanskiDepartment of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Hilary P GrocottDepartment of Anesthesiology, Perioperative and Pain Medicine, St. Boniface Hospital, University of Manitoba, CR3008-369 Tache Ave, Winnipeg, MB, R2H 2A6, Canada. hgrocott@sbgh.mb.ca.
University of Manitoba · CAGeorge & Fay Yee Centre for Healthcare Innovation · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeBlood transfusions are frequently administered in cardiac surgery. Despite a large number of published studies comparing a "restrictive" strategy with a "liberal" strategy, no clear consensus has emerged to guide blood transfusion practice in cardiac surgery patients. The purpose of this study was to identify, critically appraise, and summarize the evidence on the overall effect of restrictive transfusion strategies compared with liberal transfusion strategies on mortality, other clinical outcomes, and transfusion-related outcomes in adult patients undergoing cardiac surgery. SOURCE: We searched MEDLINE (OvidSP), EMBASE (OvidSP) and Cochrane CENTRAL (Wiley) from inception to 1 December 2017 and queried clinical trial registries and conference proceedings for randomized-controlled trials of liberal vs restrictive transfusion strategies in cardiac surgery. PRINCIPAL

findingsFrom 7,908 citations, we included ten trials (9,101 patients) and eight companion publications. Overall, we found no significant difference in mortality between restrictive and liberal transfusion strategies (risk ratio [RR], 1.08; 95% confidence interval [CI], 0.76 to 1.54; I

conclusionsIn adult patients undergoing cardiac surgery, a restrictive transfusion strategy reduces RBC transfusion without impacting mortality rate or the incidence of other perioperative complications. Nevertheless, further large trials in subgroups of patients, potentially of differing age, are needed to establish firm evidence to guide transfusion in cardiac surgery.

trial registrationPROSPERO (CRD42017071440); registered 20 April, 2018.

Indexed as

Cardiac Surgical ProceduresBlood TransfusionHumans

Identifiers

PMID32124256
OpenAlexW3009386445

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.