Benefits of nitric oxide administration during cardiopulmonary bypass on postoperative outcomes in adult patients: a meta-analysis and systematic review
Abstract
BACKGROUND: Nitric oxide (NO) is reported to play several protective roles in the inflammatory response and ischemia/reperfusion injury. This study evaluated the effect of nitric oxide (NO) on postoperative outcomes in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: We systematically searched PubMed, Web of Science, and EMBASE (inception–April 2025) for relevant RCTs. Two reviewers independently screened studies, extracted data, and assessed risk of bias (Cochrane RoB 1) and evidence certainty (GRADE). Meta-analysis was performed using random-effects models. RESULTS: Eight RCTs involving 774 patients were finally included. The use of NO did not reduce the postoperative mortality (RR 0.71, 95% CI 0.36 to 1.42), the duration of postoperative ventilation (MD -0.23 h, 95% CI -1.18 to 0.71), the length of stay in hospital (MD -0.07 days, 95% CI -0.55 to 0.42) or in intensive care unit (MD -4.17 h, 95% CI -8.74 to 0.4). This study demonstrated that NO administration significantly reduced serum levels of creatine kinase-MB at both 24 h (MD -19.36 ng/ml, 95% CI -28.72 to -10.00) and 48 h (MD -17.47 ng/ml, 95% CI -19.53 to -15.41) postoperatively, though it did not affect troponin levels. Concurrently, NO was associated with a significantly lower incidence of postoperative acute kidney injury (RR 0.78, 95% CI 0.64 to 0.93), but not with a reduced need for renal replacement therapy (RR 0.88, 95% CI 0.45 to 1.72). CONCLUSIONS: This meta-analysis of RCTs…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 774 participants or records.
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