title: Glial fibrillary acidic protein in children with congenital heart disease undergoing cardiopulmonary bypass.
abstract: OBJECTIVE
  To determine whether blood levels of the brain-specific biomarker glial fibrillary acidic protein rise during cardiopulmonary bypass for repair of congenital heart disease.
  
  
  METHODS
  This is a prospective observational pilot study to characterise the blood levels of glial fibrillary acidic protein during bypass. Children <21 years of age undergoing bypass for congenital heart disease at Johns Hopkins Hospital and Texas Children's Hospital were enrolled. Blood samples were collected during four phases: pre-bypass, cooling, re-warming, and post-bypass.
  
  
  RESULTS
  A total of 85 patients were enrolled between October, 2010 and May, 2011. The median age was 0.73 years (range 0.01-17). The median weight was 7.14 kilograms (range 2.2-86.5). Single ventricle anatomy was present in 18 patients (22%). Median glial fibrillary acidic protein values by phase were: pre-bypass: 0 ng/ml (range 0-0.35); cooling: 0.039 (0-0.68); re-warming: 0.165 (0-2.29); and post-bypass: 0.112 (0-0.97). There were significant elevations from pre-bypass to all subsequent stages, with the greatest increase during re-warming (p = 0.0001). Maximal levels were significantly related to younger age (p = 0.03), bypass time (p = 0.03), cross-clamp time (p = 0.047), and temperature nadir (0.04). Peak levels did not vary significantly in those with single ventricle anatomy versus two ventricle repairs.
  
  
  CONCLUSIONS
  There are significant increases in glial fibrillary acidic protein levels in children undergoing cardiopulmonary bypass for repair of congenital heart disease. The highest values were seen during the re-warming phase. Elevations are significantly associated with younger age, bypass and cross-clamp times, and temperature nadir. Owing to the fact that glial fibrillary acidic protein is the most brain-specific biomarker identified to date, it may act as a rapid diagnostic marker of brain injury during cardiac surgery.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Marissa A
authors.initials: MA
authors.lastname: Brunetti
authors.affiliation: 2Departments of Pediatrics and Biostatistics,Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland,United States of America.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: 3Department of Anesthesiology and Critical Care Medicine,Texas Children's Hospital and Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: R Blaine
authors.initials: RB
authors.lastname: Easley
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Melania
authors.initials: M
authors.lastname: Bembea
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Brown
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Eugenie
authors.initials: E
authors.lastname: Heitmiller
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Schwartz
authors.affiliation: 3Department of Anesthesiology and Critical Care Medicine,Texas Children's Hospital and Baylor College of Medicine,Houston,Texas,United States of America.
authors.forename: Ken M
authors.initials: KM
authors.lastname: Brady
authors.affiliation: 4Department of Cardiac Surgery,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Vricella
authors.affiliation: 5Department of Pediatrics,Johns Hopkins School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Everett
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061646:Operative Time; D010865:Pilot Projects; D011446:Prospective Studies; D017694:Rewarming
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein