Intralipid postconditioning in patients of cardiac surgery undergoing cardiopulmonary bypass (iCPB): study protocol for a randomized controlled trial

Abstract

Background Intralipid is a necessary fatty acid carrier that has been safely used as an energy supplier in the clinic. It has played an important role in rescuing the cardiac arrest caused by local anesthetic toxicity. In recent years, experimental studies have shown that intralipid postconditioning (ILPC) could reduce myocardial ischemic/reperfusion (I/R) injuries. Our research group has innovatively conducted a pilot randomized controlled trial (RCT), and the results showed that ILPC could reduce the release of cTnT and CK-MB, biomarkers of myocardial I/R injury, in valve replacement surgery. However, the potential effects of ILPC on the clinical outcome of adult cardiac surgery patients are unclear. Intralipid postconditioning in patients of cardiac surgery undergoing cardiopulmonary bypass (iCPB) trial is aimed to further study whether ILPC could improve short-term and long-term clinical outcome, as well as cardiac function in adult cardiac surgery patients. Methods The iCPB trial is an ongoing, single-center, prospective, double-blinded, large sample RCT. In total, 1000 adults undergoing cardiac surgery will be randomly allocated to either the ILPC group or the control group. The intervention group received an intravenous infusion of 2 mL/kg of 20% intralipid (medium-chain and long-chain fat emulsion injection C6~C24, Pharmaceutical) within 10 min before aortic cross-unclamping, and the control group received an equivalent volume of normal saline. The primary endpoints are complex morbidity of major complications during hospitalization and all-cause mortality within 30 days after surgery. The secondary endpoints include (1) all-cause mortality 6 months and 1 year postoperatively; (2) the quality of life within 1 year after surgery, using the QoR-15 questionnaire; (3) the postoperative cardiac function evaluated by LVEF, LVEDS, and LVEDD, and the myocardial injury evaluated by CK-MB, cTnT, and BNP; and (4) short-term clinical outcomes during hospitalization and total cost are also detailed evaluated. Discussion The iCPB trial is the first to explore ILPC on the clinical outcome of adult cardiac surgery patients. The results are expected to provide potential evidences about whether ILPC could reduce the morbidity and mortality and improve the cardiac function and quality of life. Therefore, the results will provide a rationale for the evaluation of the potentially clinically relevant benefit of intralipid therapy. Trial registration Chictr.org.cn ChiCTR1900024387. Prospectively registered on 9 July 2019.

Lung injury after cardiopulmonary bypass: Alternative treatment prospects

“…Previous research has provided evidence that intralipid reduces myocardial infarct size and improves cardiac function by pre-reperfusion infusion[ 38 , 60 , 61 ]. Yuan et al [ 62 ] recently conducted a randomized controlled trial using intralipid to assess prognosis and cardiac function in adult cardiac surgery patients after extracorporeal circulation. A single intravenous bolus of intralipid (2 mL/kg, 20%) did not cause abnormal lipid metabolism, with no perioperative hepatic or renal dysfunction, or other related complications[ 39 , 62 , 63 ].…”

“…Yuan et al [ 62 ] recently conducted a randomized controlled trial using intralipid to assess prognosis and cardiac function in adult cardiac surgery patients after extracorporeal circulation. A single intravenous bolus of intralipid (2 mL/kg, 20%) did not cause abnormal lipid metabolism, with no perioperative hepatic or renal dysfunction, or other related complications[ 39 , 62 , 63 ]. The duration of intravenous infusion of intralipid should be > 10 min as rapid administration of large amounts increases the risk of fat embolism.…”

Exploring the Mechanism of Salvianolic Acid B against Myocardial Ischemia-Reperfusion Injury Based on Network Pharmacology

“…However, reperfusion itself can lead to additional myocardial injury, known as myocardial ischemia-reperfusion injury [ 5 ]. Currently, the discussion about this pathological process is focused on oxidative stress, calcium overload, inflammatory reactions, and energy metabolism disorders, and the process has been verified in various animal models [ 6 , 7 ]. However, verapamil as a positive drug for MI/RI may increase reactive oxygen species (ROS) levels, promote oxidative stress, and cause heart failure [ 8 ].…”