Mortality and adverse events of extracorporeal haemoadsorption therapy in cardiac surgery: a systematic review and meta-analysis of randomised controlled trials
In brief
Haemoadsorption adds no survival or length-of-stay benefit in cardiac surgery
A meta-analysis of 12 randomized trials (713 patients) found that inserting a haemoadsorption filter into the bypass circuit did not lower mortality, ICU stay, or hospital stay compared with standard bypass. Adverse events and organ-support needs were also unchanged, and the evidence remains too limited to rule out a meaningful effect, highlighting the need for larger trials in high-risk patients.
- Journal
- British journal of anaesthesia (Q1)
- Published
- 21 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Harriet C A Pittaway, John M Kelly, Malcolm J Price, Dhruv Parekh, Phillip A Howells
- PMID
- 42481274
- DOI
- 10.1016/j.bja.2026.06.005
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 26 July 2026).
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 26 July 2026): Hemoadsorption in cardiac surgery meta-analysis
- Picked for Nephrology (top studies of the week, 26 July 2026).
Abstract
BACKGROUND: Extracorporeal haemoadsorption (HA) therapy has been studied in RCTs for use during cardiopulmonary bypass (CPB). CPB is known to activate a systemic inflammatory response. Haemoadsorption has the potential to mitigate this through the removal of pro-inflammatory mediators. We aimed to examine available RCT data reporting on clinically important outcomes in a systematic review and meta-analysis. METHODS: We performed a systematic review and meta-analysis involving adult patients undergoing cardiac surgery with the use of CPB. The intervention was HA inserted into the CPB circuit, and the comparator was conventional CPB without HA. The primary outcome was mortality, and secondary outcomes included adverse events, requirements for organ support, and length of stay in ICU and hospitals. RESULTS: We included 12 RCTs with 713 participants. Only one study had low risk of bias, limiting the strength of findings. Meta-analysis showed no statistically significant benefit of HA during CPB on mortality (odds in the intervention vs control group (odds ratio, 95% confidence interval [CI]=1.08, 0.59-2.01, P=0.75), hospital length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=0.21, -1.89-2.30, P=0.82) and intensive care length of stay (mean difference of the intervention vs control group (pooled mean difference, 95% CI=-0.36, -1.31-0.60, P=0.42) when compared with standard CPB. However, confidence intervals included the possibility of clinically important benefit or harm. There was also no significant difference in adverse events or requirements for ventilation, cardiovascular support or renal replacement therapy. CONCLUSIONS: This meta-analysis did not show evidence of clinical benefit for routine use of HA during CPB for cardiac surgery, although clinically relevant benefit or harm cannot be excluded on the currently available evidence. Appropriately powered and clinically focused RCTs targeting cases at the highest risk of cytokine burden are required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.