Abstract

Background. Cardiopulmonary bypass (CBP) is a form of extracorporeal circulation used in many surgical procedures; however, there is no definitive information regarding which pump head type (roller or centrifugal) results in the best patient outcomes. The purpose of this systematic review is to identify peer-reviewed literature in which pump types are compared on several outcomes, including inflammation, blood damage, cognitive decline, and other postoperative complications.

Methods. A systematic review of the literature was performed following PRISMA guidelines and reported with PROSPERO ( registration number: CRD42021257382). The review followed a three-step process to identify articles for inclusion in the study, including identifying potential records, screening records for eligibility, and evaluating included records for quality and data analysis. The authors outlined specific inclusion criteria based on study characteristics, patient population, surgical intervention, context, and primary outcomes. All studies identified as case reports, editorials, or reviews were excluded from consideration, as well as any studies that included children or adults with congenital heart defects. Covidence was utilized for quality assessment of the final articles, following their assessment template based on the Cochrane Risk of Bias 1, and also for data extraction, which included information on the study patient population, CPB pumps and circuits, and reported surgical and patient outcomes.

Results. The search yielded 803 total articles across PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, and Compendex databases. After removing duplicates and articles published prior to 2011, 361 articles remained and were uploaded to Covidence for initial title and abstract screening. Of the 19 articles selected for full review, four were later excluded for not meeting patient population criteria and having the wrong comparator information (n=15 final articles included in this analysis). Reported outcome results varied widely among the studies and were grouped into 11 sub-categories. It was found that centrifugal pumps may elicit a smaller inflammatory response, induce less hemolysis, involve less blood loss, and lower transfusion volumes of blood cells, fewer renal complications, shorter ICU times, and lower mortality rates compared to roller pumps. Results regarding differences in ischemia, microemboli generation, and post-operative cognitive decline between the two pump groups remained inconclusive.

Discussion and Conclusions. Current literature demonstrates the need to better understand postoperative complications of CPB that impact patient lives through the postsurgical continuum. While centrifugal pumps tend to cause less negative patient outcomes compared to roller pumps, further consideration is still needed to account for other CPB circuit confounding factors.