Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Umberto Benedetto, Massimo Caputo, Gustavo Guida, Chiara Bucciarelli-Ducci, Jade Thai, Alan Bryan, Gianni D Angelini

Research output: Contribution to journalReview article (Academic Journal)peer-review

6 Citations (Scopus)
230 Downloads (Pure)


Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac surgery, there is still paucity of evidence to prove its benefit in terms of neurologic protection. Therefore, we conducted a meta-analysis of available randomized controlled trials comparing CDI vs standard de-airing maneuvers. Electronic searches were performed to identify relevant randomized controlled trials. Primary outcomes investigated were postoperative stroke, neurocognitive deterioration, and in-hospital mortality. Risk difference (RD) was used as summary statistic. Pooled estimates were obtained by means of random-effects model to account for possible clinical diversity and methodological variation between studies. Eight studies were identified with 668 patients randomized to CDI (n = 332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was 2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95% confidence interval [CI] -2% to 2%; P = 0.87; I2 = 0%). Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62; I2 = 0%). Neurocognitive deterioration rate was 12% vs 21% in the CDI and control group, respectively, but this difference was not statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35; I2 = 0%). The present meta-analysis did not find any significant protective effect from the use of CDI when compared with manual de-airing maneuvers in terms of clinical outcomes, including postoperative neurocognitive decline.

Original languageEnglish
Pages (from-to)301-310
Number of pages10
JournalSeminars in Thoracic and Cardiovascular Surgery
Issue number3
Early online date23 May 2017
Publication statusPublished - 3 Dec 2017

Structured keywords

  • CRICBristol
  • Centre for Surgical Research


  • Carbon dioxide insufflation
  • cardiac surgery
  • meta-analysis

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