Document Type

Article

Publication Date

4-11-2025

Abstract

Background: Cardiopulmonary bypass (CPB) is an essential part of cardiac surgery, but it leads to SIRS (systemic inflammatory response syndrome) which in turn increases postoperative complications. There are many proposed approaches to reduce inflammation, but there is no clear best practice on the approach to use. This scoping review aims to explore the literature and classify the studies that investigate the effects of various CPB perfusion techniques on inflammatory responses to determine the possible best practices and the gaps that exist in the literature.

Methods: The present scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis with Scoping Review Extension (PRISMA-ScR) framework. The databases searched include PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science for articles published from 2016 to 2025. Out of 1,010 articles that were initially retrieved, only 22 articles were selected after applying inclusion and exclusion criteria. The selected process was part of a scoping review, focusing on mapping the literature. Surgical study designs comprised of retrospective (41%) and prospective (27%) cohort studies, case-control studies (9%), and clinical trials (23%). The most common interventions concerned the use of antifibrinolytics (32%), blood products (23%), pointof-care testing (18%), and changes to bypass circuits and priming solutions (14%).

Results: Miniaturized CPB circuits decreased the level of inflammation and the length of ICU admission. Heparin coated circuits reduced the level of TNF-α, IL-6 and IL-8 and offered better recovery. Although there were some renal and pulmonary improvements in pulsatile perfusion, there was not enough evidence to support them. Corticosteroids and nitric oxide showed moderate effectiveness in this aspect.

Conclusion: Despite these studies presenting promising results, the variations in the study methodology, sample size, and measurement indicators prevent the drawing of concrete conclusions. There is a need for additional high-quality randomized controlled trials for better CPB strategies and fewer inflammation-related complications.

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