RBC transfusions can increase oxygen availability to the tissues, but studies have provided conflicting results. The objectives of this study were, therefore, to evaluate, using systematic review and meta-analysis, the effects of transfusion on hemodynamic/oxygenation variables in patients without acute bleeding.
PubMed, Scopus, Cochrane Database of Systematic Reviews, and Embase from inception until June 30, 2019.
All articles that reported values of prespecified hemodynamic or oxygenation variables before and after RBC transfusion.
Publication year, number of patients, number of transfusions and the type of population studied, hemodynamic and oxygenation data (heart rate, cardiac index, mixed venous oxygen saturation or central venous oxygen saturation, oxygen delivery
index, oxygen consumption
index, oxygen extraction ratio, arteriovenous oxygen difference and arterial blood lactate
) before and after transfusion. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. We also performed subgroup analyses comparing septic with nonseptic patients.
We retrieved 6,420 studies; 33 met the inclusion criteria, 14 of which were in patients with sepsis
. In the meta-analysis, the estimated mean differences and 95% CIs comparing the periods before and after transfusion were –0.0 L/min/m2
(–0.1 to 0.1 L/min/m2
= 0.86) for cardiac index; –1.8 beats/min (–3.7 to 0.1 beats/min) (p
= 0.06) for heart rate; 96.8 mL/min/m2
< 0.01) for oxygen delivery
index; 2.9% (2.2–3.5%) (p
< 0.01) for mixed venous oxygen saturation or central venous oxygen saturation; –3.7% (–4.4% to –3.0%) (p
< 0.01) for oxygen extraction ratio; and 4.9 mL/min/m2
= 0.02) for oxygen consumption
index. The estimated mean difference for oxygen consumption
index in the patients with sepsis
was 8.4 mL/min/m2
Transfusion was not associated with a decrease in mean cardiac output
or mean heart rate. The increase in mean oxygen delivery
following transfusion was associated with an increase in mean oxygen consumption
after transfusion, especially in patients with sepsis