Abstract 8728: Nitric Oxide Delivery During Cardiopulmonary Bypass Reduces Postoperative Morbidity in Children - A Randomized Trial
Background: Cardiac surgery leads to reperfusion injury and endothelial dysfunction causing fluid retention, coagulopathy, and myocardial dysfunction. Gaseous nitric oxide (gNO) has been demonstrated to have a myocardial protective effect and anti-reperfusion properties. We hypothesized that gNO administration during CPB would have similar beneficial effects.
Methods: A prospective, randomized, blinded, placebo controlled study in which children undergoing repair of Tetralogy of Fallot received either 20 ppm of gNO or placebo delivered to the membrane oxygenator during CPB.
Results: 16 children consented and randomized into 2 equal groups. There were no differences in age, cross clamp time, CPB time, or methemoglobin. The NO group had a shorter time on vent (8.4 +/- 7.6 vs 16.3 +/- 6.5 hrs, p<0.05) and CICU LOS (53.8 +/- 19.7 vs 79.4 +/- 37.7 hrs, p=0.05). The NO group had lower troponin values at 12, 24, and 48 hours (p<0.05) and lower BNP at 12 and 24 hours (p<0.05) (graphs). There was a trend toward less positive fluid balance in the first 48hrs post op (+187mL vs +317mL) with significantly less diuretic usage (1.6 +/- 0.9 vs 4.0 +/- 1.0 of furosemide, and 0 vs 6.3 +/- 7.4 of chlorothiazide, both mean total dose (mg/kg) in first 48 hrs, both p<0.05). NO patients had a higher mean Hgb at 48 hrs (11.8 vs 9.8, p<0.05) despite no differences in chest tube output, PRBC transfusion, platelet counts or transfusion, FFP transfusion, or pT/pTT in the first 48hrs. There were no differences in IL6, IL8, TNF, or lactate.
Conclusions: The delivery of gNO to the CPB circuit in children undergoing cardiac surgery results in myocardial protection, improved fluid balance, and improved postoperative ICU course.
- Congenital heart surgery
- Nitric oxide
- Ischemia reperfusion
- Pediatric cardiac intensive care
- © 2011 by American Heart Association, Inc.