title: Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic Support but Does Not Impact Inflammation in Children Undergoing Surgical Ventricular Septal Defect Closure.
abstract: Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4.9 months, range 2.3-38 months; median weight 7.2 kg, range 5.2-11.7 kg) were randomized to a perfusion temperature of either 32°C (Group 1, n = 10) or 36°C (Group 2, n = 10). The clinical data and blood samples were collected before cardiopulmonary bypass, directly after aortic cross-clamp release, and 4 and 24 h after weaning from cardiopulmonary bypass. Time on ventilation as primary outcome did not differ between the two groups. Other clinical outcome parameters like fluid balance or length of stay in the intensive care were also similar in the two groups. Compared with Group 2, Group 1 needed significantly higher and longer inotropic support (P < 0.001). In Group 1, two infants had junctional ectopic tachycardia, and another had a pulmonary hypertensive crisis. Perfusion temperature did not influence cytokine release, organ injury, or coagulation. Cardiopulmonary bypass temperature does not influence time on ventilation or inflammatory marker release. However, in the present study, with a small patient cohort, patients operated under hypothermic bypass needed higher and longer inotropic support. The use of hypothermic cardiopulmonary bypass in infants and children should be approached with care.
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Katharina Rose Luise
authors.initials: KR
authors.lastname: Schmitt
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Fedarava
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Georgia
authors.initials: G
authors.lastname: Justus
authors.affiliation: Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Redlin
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Böttcher
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Delmo Walter
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.|Department of Pediatrics, Division of Cardiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Miera
mesh_terms: D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000379:methods*; D016207:Cytokines / Q000097:blood; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000097:blood / Q000150:complications / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D007249:Inflammation / Q000097:blood / Q000150:complications; D008297:Male; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications; D016896:Treatment Outcome
chemical_list: D016207:Cytokines
keywords: Cardiopulmonary bypass; Hypothermia; Inflammation; Ventricular septal defect