Paediatric cardiopulmonary bypass surgery: the challenges of heterogeneity and identifying a meaningful endpoint for clinical trials

Pappachan, John; Brown, Kate; Tibby, Shane M.

doi:10.1007/s00134-016-4622-y

Cited by 8 publications

(2 citation statements)

References 15 publications

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“…153 Endocrine medications have the potential to significantly alter post-operative outcomes and should be investigated further. 156 In all medication classes, drug dose and interval varied widely, in part due to lack of label or other consensus-based recommendations. This complicates the evaluation of doseefficacy and dose-safety relationships in this population.…”

Section: Other Endocrine Medicationsmentioning

confidence: 99%

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

et al. 2021

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Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

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Section: Other Endocrine Medicationsmentioning

confidence: 99%

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

et al. 2021

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“…Individuals, particularly children, undergoing cardiac surgery with cardiopulmonary bypass (CPB) may suffer from severe organ injury (1)(2)(3). Indeed, CPB induces an inflammatory response that can cause many serious complications, including renal failure, liver dysfunction, acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS).…”

Section: Introductionmentioning

confidence: 99%

Adenosine A2a�receptor agonist CGS21680 treatment attenuates cardiopulmonary bypass‑associated inflammatory lung injury in juvenile rats

et al. 2019

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The adenosine a2a receptor agonist cGS21680 has been suggested to act as an anti-inflammatory agent that protects against cardiopulmonary bypass (CPB)-induced organ injury. However, the therapeutic effects of CGS21680 for CPB-induced lung injury have not been comprehensively evaluated. Using a juvenile rat model, the present study was designed to evaluated whether CGS21680 attenuates CPB-induced lung injury. Our juvenile rat CPB model was established by 60 min CPB with or without CGS21680 pretreatment (100 µg/kg, in the CPB priming solution). Rats in the Sham group only underwent cannulation and heparinization. Serum and pulmonary levels of inflammatory markers and histological features of pulmonary tissues were analyzed. All juvenile rats survived following CPB. Significantly elevated serum levels of tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO) and interleukin-1β (IL-1β), and decreased glutathione peroxidase (GSH-PX) levels were observed in the CPB group compared to the Sham group (all P<0.05). TNF-α, MPo and il-1β were significantly decreased, while GSH-PX was markedly increased in the CGS group when compared to the CPB group. Consistently, pulmonary tissues from rats in the CPB group showed considerable amounts of damaged pneumocytes, severe edema, and increased alveolar macrophages, and significantly higher lung injury scores compared to the controls. Collectively, these changes were all further attenuated by CGS21680. Pretreatment with CGS21680 before CPB attenuated pulmonary injury, which may be related to the anti-inflammatory effects of CGS21680 downstream of A2a receptor activation.

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Pediatric Cardiorenal Syndromes

Giorni

Rizza

Ricci

2020

Textbook of Cardiorenal Medicine

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Paediatric cardiopulmonary bypass surgery: the challenges of heterogeneity and identifying a meaningful endpoint for clinical trials

Cited by 8 publications

References 15 publications

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

Adenosine A2a�receptor agonist CGS21680 treatment attenuates cardiopulmonary bypass‑associated inflammatory lung injury in juvenile rats

Pediatric Cardiorenal Syndromes

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