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Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass

Published online by Cambridge University Press:  08 July 2016

Benjamin S. Schmidt Open the ORCID record for Benjamin S. Schmidt [Opens in a new window] ,
James E. Jordan ,
Magan R. Lane ,
Vanessa M. DiPasquale ,
Lori P. Graf ,
Yoshio Ootaki  and
Ross M. Ungerleider
Benjamin S. Schmidt
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
James E. Jordan
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Magan R. Lane
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Vanessa M. DiPasquale
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Lori P. Graf
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Yoshio Ootaki
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
Ross M. Ungerleider*
Affiliation:
Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
*
Correspondence to: R. Ungerleider MD, MBA, Brenner Children’s Hospital, Wake Forest Baptist Medical Center, Ardmore Tower, 10th Floor, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America. Tel: 336-716-1380; Fax: 336-716-3348; E-mail: rungerle@wakehealth.edu
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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.

Keywords

Cardiopulmonary bypassneonatalcongenital heart surgeryblood transfusioninflammationasanguinous prime
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 480 - 487
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Copyright
© Cambridge University Press 2016 

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