Pulsatile Versus Nonpulsatile Cardiopulmonary Bypass Flow: An Evidence-Based Approach

Objective: To derive evidence-based recommendations for the use of pulsatile perfusion (PP) technique for the reduction of mortality and nonfatal complications after elective coronary artery bypass grafting surgery (CABG).

Outcomes: Incidence of total mortality, myocardial infarction (MI), stroke, and renal failure during hospital stay. Evidence: Medline, Embase, and the Cochrane controlled trial register (CCTR) on the Cochrane library were searched from the earliest achievable date of each database to March 2005. No language restrictions were applied. Retrieved reprints were evaluated according to a priori inclusion criteria, and those included were critically appraised using established internal validity criteria.

Benefits and harms: Only one fair quality randomized controlled trial demonstrated the beneficial effect of PP in reducing the incidence of total mortality and MI. No studies demonstrated the beneficial effect of PP in reducing the incidence of stoke or renal failure. One randomized controlled trial demonstrated that PP was associated with increased hemolysis compared to nonpulsatile (NP) perfusion.

Conclusion: The evidence is conflicting and therefore does not support making recommendation for or against routinely providing the PP to reduce the incidence of mortality or MI. The evidence is insufficient to recommend for or against routinely providing the pulsatile profusion to reduce the incidence of stroke or renal failure.