The efficacy of hemoglobin spray in wound management: a systematic review and network meta-analysis of comparative studies

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Abstract
Purpose There is no evidence comparing the treatment results of hemoglobin spray and hyperbaric oxygen therapy (HBOT) in chronic wounds. Therefore, we conducted a systematic review and network meta-analysis to explore the efficacy and role of hemoglobin spray in the treatment of chronic wounds. The probabilities of being the best treatment option were estimated and ranked between hemoglobin spray and HBOT. Methods A systematic review and network meta-analysis (NMA) were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines and PROSPERO number: CRD42020161396. Results A total of 934 studies were identified from PUBMED and SCOPUS databases, and 112 articles were deleted. Among the 24 studies, 16 RCTs and eight cohort studies met our inclusion criteria. In direct meta-analysis, HBOT had higher proportion of wound healing rate than control with pooled risk ratios (RRs) of 1.67 (95%CI: 1.10, 2.52). Hemoglobin spray had a higher wound healing rate than the control, with a pooled odds ratio (OR) of 1.92 (95%CI: 1.35, 2.73). In the network meta-analysis, the probability of being the best treatment was hemoglobin spray, followed by hyperbaric, with surface under the cumulative ranking curve (SUCRAs) of 67.9, and 32.1, respectively. Conclusions Our evidence suggests that the proportion of wound healing in the hemoglobin spray and HBOT groups was higher than that in the control group. A network meta-analysis demonstrated that hemoglobin spray had the highest chance of treatment success. There is a need for further studies using well-designed RCTs and updated meta-analyses to provide enough evidence to compare the effectiveness of hemoglobin spray and HBOT in clinical practice.

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