Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-29T12:54:00.288Z Has data issue: false hasContentIssue false
  • English
  • Français

Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass

Published online by Cambridge University Press:  08 July 2016

Benjamin S. Schmidt Open the ORCID record for Benjamin S. Schmidt [Opens in a new window] ,
James E. Jordan ,
Magan R. Lane ,
Vanessa M. DiPasquale ,
Lori P. Graf ,
Yoshio Ootaki  and
Ross M. Ungerleider
Benjamin S. Schmidt
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
James E. Jordan
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Magan R. Lane
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Vanessa M. DiPasquale
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Lori P. Graf
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Yoshio Ootaki
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Ross M. Ungerleider*
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
*
Correspondence to: R. Ungerleider MD, MBA, Brenner Children’s Hospital, Wake Forest Baptist Medical Center, Ardmore Tower, 10th Floor, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America. Tel: 336-716-1380; Fax: 336-716-3348; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Complications from systemic inflammation are reported in neonates following exposure to cardiopulmonary bypass. Although the use of asanguinous primes can reduce these complications, in neonates, this can result in significant haemodilution, requiring addition of blood. This study investigates whether the addition of blood after institution of bypass alters the inflammatory response compared with a blood prime. Neonatal swine were randomised into four groups: blood prime, blood after bypass but before cooling, blood after cooling but before low flow, and blood after re-warming. All groups were placed on central bypass, cooled, underwent low flow, and then re-warmed for a total bypass time of 2 hours. Although haematocrit values between groups varied throughout bypass, all groups ended with a similar value. Although they spent time with a lower haematocrit, asanguinous prime groups did not have elevated lactate levels at the end of bypass compared with blood prime. Asanguinous primes released less tumour necrosis factor α than blood primes (p=0.023). Asanguinous primes with blood added on bypass produced less interleukin 10 and tumour necrosis factor α (p=0.006, 0.019). Animals receiving blood while cool also showed less interleukin 10 and tumour necrosis factor α production than those that received blood warm (p=0.026, 0.033). Asanguinous primes exhibited less oedema than blood primes, with the least body weight gain noted in the end cool group (p=0.011). This study suggests that using an asanguinous prime for neonates being cooled to deep hypothermia is practical, and the later addition of blood reduces inflammation.

Keywords

Cardiopulmonary bypassneonatalcongenital heart surgeryblood transfusioninflammationasanguinous prime
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 480 - 487
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Levy, JH, Tanaka, KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 2003; 75: S715–S720.CrossRefGoogle ScholarPubMed
2. Hauser, GJ, Ben-Ari, J, Colvin, MP, et al. Interleukin-6 levels in serum and lung lavage fluid of children undergoing open heart surgery correlate with postoperative morbidity. Intensive Care Med 1998; 24: 481–486.CrossRefGoogle ScholarPubMed
3. Scott, BH, Seifert, FC, Glass, PS, Grimson, R. Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Anesth Analg 2003; 97: 958–963.CrossRefGoogle ScholarPubMed
4. Aĝirbaşli, M, Nguyen, M-L, Win, K, et al. Inflammatory and hemostatic response to cardiopulmonary bypass in pediatric population: feasibility of seriological testing of multiple biomarkers. Artif Organs 2010; 34: 987–995.CrossRefGoogle ScholarPubMed
5. Jonas, R a, Wypij, D, Roth, SJ, et al. The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants. J Thorac Cardiovasc Surg 2003; 126: 1765–1774.CrossRefGoogle ScholarPubMed
6. Hickey, E, Karamlou, T, You, J, Ungerleider, RM. Effects of circuit miniaturization in reducing inflammatory response to infant cardiopulmonary bypass by elimination of allogeneic blood products. Ann Thorac Surg 2006; 81: S2367–S2372.CrossRefGoogle ScholarPubMed
7. Newburger, JW, Jonas, RA, Soul, J, et al. Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery. J Thorac Cardiovasc Surg 2008; 135: 347–354.e4.CrossRefGoogle ScholarPubMed
8. Wypij, D, Jonas, RA, Bellinger, DC, et al. The effect of hematocrit during hypothermic cardiopulmonary bypass in infant heart surgery: results from the combined Boston hematocrit trials. J Thorac Cardiovasc Surg 2008; 135: 355–360.CrossRefGoogle ScholarPubMed
9. Karamlou, T, Schultz, JM, Silliman, C, et al. Using a miniaturized circuit and an asanguineous prime to reduce neutrophil-mediated organ dysfunction following infant cardiopulmonary bypass. Ann Thorac Surg 2005; 80: 6–13; discussion 13–14.CrossRefGoogle Scholar
10. Feuerstein, G, Wang, X, Barone, FC. Cytokines in brain ischemia – the role of TNF alpha. Cell Mol Neurobiol 1998; 18: 695–701.CrossRefGoogle ScholarPubMed
11. Silverstein, FS, Barks, JD, Hagan, P, Liu, XH, Ivacko, J, Szaflarski, J. Cytokines and perinatal brain injury. Neurochem Int, 30: 375–383.CrossRefGoogle Scholar
12. Golab, HD, Takkenberg, JJ, Bogers, AJJC. Specific requirements for bloodless cardiopulmonary bypass in neonates and infants: a review. Perfusion 2010; 25: 237–243.CrossRefGoogle ScholarPubMed
13. Golab, HD, Bogers, JJC. Small, smaller, smallest. Steps towards bloodless neonatal and infant cardiopulmonary bypass. Perfusion 2009; 24: 239–242.CrossRefGoogle ScholarPubMed
14. Alcaraz, AJ, Manzano, L, Sancho, L, et al. Different proinflammatory cytokine serum pattern in neonate patients undergoing open heart surgery. Relevance of IL-8. J Clin Immunol 2005; 25: 238–245.CrossRefGoogle ScholarPubMed
15. Qing, M, Vazquez-Jimenez, JF, Klosterhalfen, B, et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock 2001; 15: 372–377.CrossRefGoogle ScholarPubMed
16. Hövels-Gürich, HH, Schumacher, K, Vazquez-Jimenez, JF, et al. Cytokine balance in infants undergoing cardiac operation. Ann Thorac Surg 2002; 73: 601–608; discussion 608–609.CrossRefGoogle ScholarPubMed
17. Taniguchi, T, Koido, Y, Aiboshi, J, Yamashita, T, Suzaki, S, Kurokawa, A. Change in the ratio of interleukin-6 to interleukin-10 predicts a poor outcome in patients with systemic inflammatory response syndrome. Crit Care Med 1999; 27: 1262–1264.CrossRefGoogle ScholarPubMed