Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study

Golab, Hanna D.; Scohy, Thierry V.; Jong, Peter L. de; Kissler, J.; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C.

doi:10.1016/j.ejcts.2010.09.040

Cited by 32 publications

(29 citation statements)

References 22 publications

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“…Similarly, in pediatric patients undergoing complex congenital corrective operations, many will have acute post-operative complications such as tissue edema with postoperative weight gain (Golab et al, 2011), systemic coagulation disorders (Hayash et al, 2011), surgical complications and low output syndrome (up to 25%) (Wernovsky et al, 1995; Hoffman et al, 2003), arrhythmias (27–48%) (Delaney et al, 2006), renal dysfunction (up to 30%) (Rosner and Okusa, 2006), and cerebral dysfunction and stroke (5–10%) (Chen et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

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Despite surgical proficiency and innovation driving low mortality rates in cardiac surgery, the disease severity, comorbidity rate, and operative procedural difficulty have increased. Today's cardiac surgery patient is older, has a “sicker” heart and often presents with multiple comorbidities; a scenario that was relatively rare 20 years ago. The global challenge has been to find new ways to make surgery safer for the patient and more predictable for the surgeon. A confounding factor that may influence clinical outcome is high K+ cardioplegia. For over 40 years, potassium depolarization has been linked to transmembrane ionic imbalances, arrhythmias and conduction disturbances, vasoconstriction, coronary spasm, contractile stunning, and low output syndrome. Other than inducing rapid electrochemical arrest, high K+ cardioplegia offers little or no inherent protection to adult or pediatric patients. This review provides a brief history of high K+ cardioplegia, five areas of increasing concern with prolonged membrane K+ depolarization, and the basic science and clinical data underpinning a new normokalemic, “polarizing” cardioplegia comprising adenosine and lidocaine (AL) with magnesium (Mg2+) (ALM™). We argue that improved cardioprotection, better outcomes, faster recoveries and lower healthcare costs are achievable and, despite the early predictions from the stent industry and cardiology, the “cath lab” may not be the place where the new wave of high-risk morbid patients are best served.

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Section: Introductionmentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

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“…In addition, recent findings indicate the importance of maintaining normal colloid osmotic pressure during CPB. 15,16 Colloid osmotic pressure was not assessed in the current study, but will be the focus of a future investigation. In addition, we would like to consider using hydroxyethyl starch formulations and albumin preparations in future studies.…”

Section: Discussionmentioning

confidence: 95%

Cardiopulmonary Bypass with Low- Versus High-Priming Volume: Comparison of Inflammatory Responses in a Rat Model

Fujii

Shirai²,

Takewa³

et al. 2016

ASAIO Journal

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A cardiopulmonary bypass (CPB) can preserve life. However, interactions between blood and large artificial surfaces might help to provoke a series of chain reactions during CPB that result in the formation and release of numerous powerful inflammatory mediators including hormones and autacoids. We postulated that small CPB circuits with reduced priming volumes and less surface areas that come into contact with blood would attenuate systemic inflammatory responses by reducing the levels of cytokines and organ tissue damage during CPB. Rats were assigned to groups that underwent CPB with a high priming volume (PV) of 15 ml and a surface area of 0.044 m or a low PV of 7 ml and a surface area of 0.034 m. We measured serum levels of cytokines and biochemical markers during CPB. Levels of proinflammatory cytokines and biochemical markers were significantly elevated in the group with a high PV, than low PV at 60 min, whereas none of these factors significantly differed between the groups at 120 min. These data suggested that in addition to blood being in contact with surfaces, the duration of CPB exposure is also an important factor for nonlinear time variances in damage caused by the systemic inflammatory response.

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“…Pump prime. During the pre-bypass period, the pump prime is adjusted to a physiologically balanced solution, with a desirable hematocrit, procoagulant levels, and oncotic pressure [ 162 ]. Other additives may include antibiotics, antifi brinolytic agents, and corticosteroids.…”

Section: Pre-bypass Periodmentioning

confidence: 99%