title: Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass.
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.
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Benjamin S
authors.identifier: http://orcid.org/0000-0002-4947-2725
authors.initials: BS
authors.lastname: Schmidt
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: James E
authors.initials: JE
authors.lastname: Jordan
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Magan R
authors.initials: MR
authors.lastname: Lane
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: DiPasquale
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Lori P
authors.initials: LP
authors.lastname: Graf
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ootaki
authors.affiliation: Department of Cardiothoracic Surgery,Wake Forest School of Medicine,Winston-Salem,North Carolina,United States of America.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Ungerleider
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001803:Blood Transfusion / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D004195:Disease Models, Animal; D011300:Preoperative Care; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
keywords: Cardiopulmonary bypass; asanguinous prime; blood transfusion; congenital heart surgery; inflammation; neonatal