Reducing risk in infant cardiopulmonary bypass: The use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow

Karamlou, Tara; Hickey, Edward; Silliman, Christopher C.; Shen, Irving; Ungerleider, Ross M.

doi:10.1053/j.pcsu.2005.01.007

Cited by 19 publications

(12 citation statements)

References 95 publications

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“…Although hemodilution during CPB increases both early neurologic complications and late neurocognitive performance, the use of homologous blood potentially exaggerates the CPB-derived inflammatory response and may contribute to post-CPB neurologic morbidity. Though miniaturization of the CPB circuit has reduced priming volume, [1][2][3] at the present time, however, it is still not low enough to achieve an acceptable level of hemodilution in very small patients.…”

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confidence: 96%

Use of Hemoglobin Vesicles During Cardiopulmonary Bypass Priming Prevents Neurocognitive Decline in Rats

et al. 2006

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Background— Homologous blood use is considered to be the gold standard for cardiopulmonary bypass (CPB) priming in infants despite exposure of the patient to potential cellular and humoral antigens. However, the use of hemoglobin vesicles (HbVs), artificial oxygen carriers that encapsulate a concentrated hemoglobin solution within phospholipid bilayer membranes, for CPB priming may prevent neurocognitive decline in infants. The goal of this study was to determine whether HbV use offsets hemodilution caused by patient/priming volume-mismatched CPB and thereby prevents the development of postoperative neurocognitive deficits. Methods and Results— CPB was established in 28 male Sprague-Dawley rats (age, 14 to 16 weeks; weight, 450 grams) after cannulation of the tail artery and right atrium. The animals were randomly assigned to 1 of 3 groups: sham surgery (n=9), HbV (−) prime (n=10), or HbV (+) prime (n=9). CPB was conducted for 90 minutes at 200 mL/kg per minute. The hematocrit during CPB was 10.0±1.2% in the HbV (+) prime group and 9.9±1.3% in the HbV (−) prime group ( P =not significant). Learning and memory function were evaluated using 2 different maze tests (Maze-1 and Maze-2, in which the arrival times to the target were measured on the first, third, fifth, and seventh postoperative days). Learning and memory function were significantly better in the HbV (+) prime group than in the HbV (−) prime group (Maze-1, P =0.012; Maze-2, P =0.042); there was no difference between the HbV (+) prime and the sham surgery group. Conclusions— The use of HbV for CPB priming may serve as a substitute for homologous blood to prevent the unacceptable hemodilution and contribute to maintenance of intact neurocognitive function.

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confidence: 96%

Use of Hemoglobin Vesicles During Cardiopulmonary Bypass Priming Prevents Neurocognitive Decline in Rats

et al. 2006

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“…14,15) The reduction of priming volume can improve postoperative hemodynamics. 16) We reported that the miniaturized biocompatible circuits reduced the perioperative inflammatory response resulting in reduced postoperative systemic edema and postoperative mechanical ventilation time in neonates and small infants. 9) Blood products, especially when stored, amplify inflammatory responses by delaying polymorphonuclear neutrophil (PMN) apoptosis and enhancing PMN priming.…”

Section: Discussionmentioning

confidence: 99%

“…However, whole blood transfusions generate inflammatory responses and may contribute to organ dysfunction following a cardiopulmonary bypass. 5) In 2005, Karamlou, et al 6) reported that employment of a miniaturized circuit and an asanguineous prime reduces inflammation and had salutary effects on cardiopulmonary function in two extracorporeal circuits of rabbit models. We established a miniaturized (< 190 mL, minimum 140 mL) and biocompatible poly (2-methoxyethylacrylate) (PMEA) coated bypass system to reduce the perioperative inflammatory responses and avoid homologous blood transfusion.…”

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confidence: 99%

The Influences of Red Blood Cell Transfusion on Perioperative Inflammatory Responses Using a Miniaturized Biocompatible Bypass With an Asanguineous Prime

et al. 2009

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SummaryWhole blood transfusion generates an inflammatory response and may contribute to organ dysfunction following cardiopulmonary bypass. We established a miniaturized (minimum 140 mL) and biocompatible bypass system to reduce perioperative inflammatory responses and avoid blood transfusions. This study was designed to reveal the influences of stored red blood cell (RBC) transfusions on perioperative inflammatory responses in infants.Fifty-four consecutive patients weighing 4-10 kg who underwent surgical procedures for complex heart anomalies with asanguineous prime were retrospectively reviewed. Twenty-two patients (40.7%) received RBC transfusions during CPB. The postoperative peak white blood cell count (p-WBC), peak neutrophil count (p-NC), and peak C-reactive protein (p-CRP) were compared for both patient groups. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the perioperative inflammatory responses.The p-CRP and p-NC in patients with transfusion was significantly greater than those in patients without transfusion (CRP 8.1 ± 5.1 versus 5.5 ± 3.0 mg/dL, P < 0.05, p-NC 14.6 ± 4.5 versus 12.0 ± 4.0 × 1000/mm 3 , P < 0.05). Multivariate analyses showed that RBC transfusion most affected p-WBC (coefficient: 3.89, 95% confidence interval [CI] 0.79-6.99, P = 0.015) and p-NC (coefficient: 3.64, 95% CI 0.87-6.40, P = 0.011). The RBC transfusions increased the perioperative inflammatory responses, compared to transfusion-free procedures, even when using a miniaturized biocompatible bypass with an asanguineous prime. (Int Heart J 2009; 50: 581-589)

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“…Activation of the coagulation and fibrinolytic system and the complement system caused by contact between blood components and the inner surface of CPB-circuit as a foreign body, as well as systemic inflammatory responses (SIR) have been reported to be lower when CPB-circuit is smaller. [28][29][30] CPB-circuit volume should be an indirect risk factor for SSIs from the immunological perspective. As cytokines were not measured, we were unable to verify the hypothesis that mediastinitis and other SSIs were induced by immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

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Reducing risk in infant cardiopulmonary bypass: The use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow

Cited by 19 publications

References 95 publications

Use of Hemoglobin Vesicles During Cardiopulmonary Bypass Priming Prevents Neurocognitive Decline in Rats

Use of Hemoglobin Vesicles During Cardiopulmonary Bypass Priming Prevents Neurocognitive Decline in Rats

The Influences of Red Blood Cell Transfusion on Perioperative Inflammatory Responses Using a Miniaturized Biocompatible Bypass With an Asanguineous Prime

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

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