Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure

Abstract

Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P < 0.001). In Group 1, two infants had junctional ectopic tachycardia, and another had a pulmonary hypertensive crisis. Perfusion temperature did not influence cytokine release, organ injury, or coagulation. Cardiopulmonary bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care.

Targeting of cell-free DNA by DNase I diminishes endothelial dysfunction and inflammation in a rat model of cardiopulmonary bypass

“…Despite major improvements in circuit design, oxygenators and the advent of heparin-bonded surfaces, the inflammatory response to CPB remains a clinical concern. There have been several attempts to attenuate postoperative cytokine release including anti-inflammatory therapy 24 , modifications in the bypass circuit 25 or changing temperature management in CPB 26 .…”

2016 survey about temperature management during extracorporeal circulation in China

“…18,20 Furthermore, after enhancing the perfusion temperature, the effect of the hypothermic sympathetic response and increased blood viscosity on the hemodynamic effects weakens, resulting in the requirement of a higher dose of vasoconstrictors to maintain satisfactory perfusion pressure. 18,21 In contrast to hypothermic CPB, the increase in perfusion temperature may increase the effective dose of the anesthetic drug. 22 In 2011, a Canadian survey showed that more than 90% of institutions involved maintained a core temperature of 32-34℃ during CPB.…”

Delirium in Children after Cardiac Surgery: Brain Resuscitation

“…In the conditions of modern anesthetic technology and perfusion, a considerable amount of information has accumulated on various methods of preventing SIR, which are effective to a greater or lesser extent. We offer an overview of the most commonly used methods for the prevention of SIR (see Table 2) [43,[78][79][80][81][82][83][84][85][86][87][88][89].…”