Continuous venous blood filtration for severe acute pancreatitis

Review question

Can continuous venous blood filtration reduce numbers of deaths in people with severe acute pancreatitis?

Background

Severe acute pancreatitis is associated with a high death rate and life-threatening complications. Continuous veno-venous hemofiltration (CVVH; continuous filtration of blood from vein) has been used in some centers to reduce complications and death, but it is unknown if CVVH is beneficial for patients.

Study characteristics

We searched for all relevant, well-conducted studies conducted up to September 2019. We included two randomized controlled trials (experiments in which participants are randomly allocated to two or more interventions, possibly including a control intervention or no intervention, and the results are compared). One study randomized 64 people with severe acute pancreatitis to receive either CVVH (32 people) or no intervention (32 people). The other study randomized 30 people with severe acute pancreatitis to receive either high-volume (high-speed) CVVH (15 people) or standard CVVH (15 people).

Key results: continuous veno-venous hemofiltration versus no intervention

There were no in-hospital deaths in either group. We cannot tell from our results whether CVVH has an important effect on death or complications for people with severe acute pancreatitis because the sample size was small.

Key results: one type of continuous veno-venous hemofiltration versus a different type of continuous veno-venous hemofiltration

High-volume CVVH may have little to no difference on numbers of in-hospital deaths (20.0% with high-volume CVVH versus 33.3% with standard CVVH). We are uncertain whether high-volume CVVH reduces numbers of adverse events (13.3% in both groups). We cannot tell from our results whether high-volume CVVH is superior, equivalent or inferior to standard CVVH for people with severe acute pancreatitis because the sample size was small and the results were imprecise.

Quality of the evidence

Most of the included studies had some limitations in terms of how they were conducted or reported. Overall, the quality of the evidence varied from very low to low.

Authors' conclusions: 

The quality of the current evidence is very low or low. For both comparisons addressed in this review, data are sparse. It is unclear whether CVVH has any effect on mortality or complications in patients with severe acute pancreatitis. It is also unclear whether high-volume CVVH is superior, equivalent or inferior to standard CVVH in patients with severe acute pancreatitis.

Read the full abstract...
Background: 

Severe acute pancreatitis is associated with high rates of mortality and life-threatening complications. Continuous veno-venous hemofiltration (CVVH) has been used in some centers to reduce mortality and avoid local or systemic complications, however its efficiency and safety is uncertain.

Objectives: 

To assess the benefits and harms of CVVH in patients suffering from severe acute pancreatitis; to compare the effects of different CVVH techniques; and to evaluate the optimal time for delivery of CVVH.

Search strategy: 

We searched the Cochrane Library (2019, Issue 8), MEDLINE (1946 to 13 September 2019), Embase (1974 to 13 September 2019), and Science Citation Index Expanded (1982 to 13 September 2019).

Selection criteria: 

We included all randomized controlled trials (RCTs) that compared CVVH versus no CVVH in participants with severe acute pancreatitis. We also included RCTs that compared different types of CVVH and different schedules for CVVH in participants with severe acute pancreatitis.

Data collection and analysis: 

Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes, and the mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs).

Main results: 

We included two studies, involving a total of 94 participants, in the review.

Continuous veno-venous hemofiltration versus no intervention

We included one study in which 64 participants with severe acute pancreatitis were randomized to undergo CVVH (32 participants) or no intervention (32 participants). There were no deaths in either group (very low-quality evidence). Adverse events, length of stay in the intensive care unit (ICU), length of hospital stay, total hospital cost, and quality of life were not reported in the study.

One type of continuous veno-venous hemofiltration versus a different type of continuous veno-venous hemofiltration

We included one study in which 30 participants with severe acute pancreatitis were randomized to undergo high-volume CVVH (15 participants) or standard CVVH (15 participants). High-volume CVVH may lead to little or no difference in in-hospital mortality rates (20.0% in the high-volume CVVH group versus 33.3% in the standard CVVH group; risk ratio (RR) 0.60, 95% confidence interval (CI) 0.17 to 2.07; 30 participants; 1 study; low-quality evidence). We are uncertain whether high-volume hemofiltration reduces rates of adverse events (13.3% in both groups; RR 1.00, 95% CI 0.16 to 6.20; 30 participants; 1 study; very low-quality evidence). Length of ICU stay, length of hospital stay, total hospital cost, and quality of life were not reported in the study.

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