Proinflammatory cytokine release during pediatric cardiopulmonary bypass: influence of centrifugal and roller pumps.
OBJECTIVE
It has been proposed that nonocclusive centrifugal pumps may elicit less blood cell trauma and hence a reduced inflammatory response than standard roller pumps. However, there have been no reports describing the impact of such pumps on proinflammatory cytokine release in pediatric cohorts.


METHODS
A prospective randomized study was undertaken.


METHODS
A regional cardiothoracic center of a university hospital.


METHODS
Thirty-four pediatric patients undergoing cardiopulmonary bypass (CPB) for the correction of complex congenital heart defects were recruited.


METHODS
Either standard twin roller (n = 17), or centrifugal vortex (Biopump, Medtronic Biomedicus Inc, MN) (n = 17) blood pumping.


RESULTS
Venous blood was drawn (1) on induction of anesthesia, (2) 5 minutes on bypass, (3) end of CPB, (4) 30 minutes post-protamine, (5) 2 hours and (6) 24 hours postoperation. Neutrophil count, level of plasma leukocyte elastase, terminal complement complex (C5b-9); interleukin-6 (IL-6) and interleukin-8 (IL-8) were increased during and after CPB compared with the postinduction baseline. C5b-9 levels in both groups peaked at the end of CPB before returning to baseline at 24 hours: (median [range]), 564 (16 to 1,136) ng/mL in centrifugal group versus 508 (0 to 1,128) ng/mL in the roller group. IL-6 in both groups reached its peak level at 2 hours postprotamine (208 [98 to 411] pg/mL in centrifugal versus 205 [60-327] pg/mL in the roller group), before coming back to baseline at 24 hours. Plasma leukocyte elastase and IL-8 reached their maximum level 15 minutes after protamine administration: 215 (64 to 375) pg/mL in centrifugal versus 235 (87 to 410) pg/mL in roller group; and 700 (90 to 5,925) ng/mL versus 362 (120 to 3,400) ng/mL, respectively.


CONCLUSIONS
The current study confirms the proinflammatory nature of pediatric CPB surgery, but failed to show a significant advantage of centrifugal pumping over roller perfusion in terms of the inflammatory response.
Ashraf
S S
SS
Department of Cardiothoracic Surgery, Leeds General Infirmatory, UK.
Tian
Y
Y
Cowan
D
D
Shaikh
R
R
Parsloe
M
M
Martin
P
P
Watterson
K G
KG
D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D002498:Centrifugation; D002675:Child, Preschool; D015938:Complement Membrane Attack Complex / Q000032:analysis; D016207:Cytokines / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D009504:Neutrophils; D011446:Prospective Studies
D015938:Complement Membrane Attack Complex; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8