Comparison of Parameters for Detection of Splanchnic Hypoxia in Children Undergoing Cardiopulmonary Bypass With Pulsatile Versus Nonpulsatile Normothermia or Hypothermia During Congenital Heart Surgeries

Abstract

The aim of this study is to evaluate gastric mucosal oxygenation together with whole-body oxygen changes in infants undergoing congenital heart surgery with cardiopulmonary bypass (CPB) procedure and the use of either pulsatile or nonpulsatile mode of perfusion with normothermia and pulsatile or nonpulsatile moderate hypothermia. Sixty infants undergoing congenital cardiac surgery were randomized into four groups as: nonpulsatile normothermia CPB (NNCPB, n = 15), pulsatile normothermia CPB (PNCPB, n = 15), nonpulsatile moderate hypothermia CPB (NHCPB, n = 15), and pulsatile moderate hypothermia CPB (PHCPB, n = 15) groups. In NNCPB and PNCPB groups, mild hypothermia was used (35°C), whereas in NHCPB and PHCPB groups, moderate hypothermia (28°C) was used. Gastric intramucosal pH (pHi), whole-body oxygen delivery (DO(2)) and consumption (VO(2)), and whole-body oxygen extraction fraction were measured at sequential time points intraoperatively and up to 2 h postoperatively. The measurement of continuous tonometry data was collected at desired intervals. The values of DO(2), VO(2), and whole-body oxygen extraction fraction were not different between groups before CPB and during CPB, whereas the PNCPB group showed higher values of DO(2), VO(2), and whole-body oxygen extraction fraction compared to the other groups at the measurement levels of 20 and 60 min after aortic cross clamp, end of CPB, and 2 h after CPB (P < 0.0001). Between groups, no difference was observed for pHi, lactate, and cardiac index values (P > 0.05). This study shows that the use of normothermic pulsatile perfusion (35°C) provides better gastric mucosal oxygenation as compared to other perfusion strategies in neonates and infants undergoing congenital heart surgery with CPB procedures.

Systematic Review and Meta‐Analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery

“…Of the remained 3032 studies were selected by review of title and abstract, 148 studies were retrieved for full text review. Finally, seven RCTs were included according to our prespecified inclusion criteria, enrolling 419 pediatric patients undergoing cardiac surgery from seven countries (Figure ). Study methodological quality is listed (Table ).…”

In Vitro Comparison of the Delivery of Gaseous Microemboli and Hemodynamic Energy for a Diagonal and a Roller Pump During Simulated Infantile Cardiopulmonary Bypass Procedures

“…Quantitative measures such as total hemodynamic energy (THE) have been used to determine the efficacy of the pump in providing adequate perfusion. Evidence suggests that increased pulsatile perfusion, quantified by surplus hemodynamic energy (SHE), improves patient outcome by minimizing inflammatory response as well as improving vital organ recovery . Using orthogonal polarization spectral imaging, O'Neil et al demonstrated that pulsatile perfusion during CPB was able to better preserve the microcirculation and resulted in less leukocyte activation compared with conventional nonpulsatile perfusion .…”

Impact of a Unique International Conference on Pediatric Mechanical Circulatory Support and Pediatric Cardiopulmonary Perfusion Research

“…Not only the quantity, but also the quality of these articles generated by this event based on high‐impact factors (average impact factor is greater than 2.7 annually) are also very impressive. Only during the last 2 years' events, topics covered show the clear evidence of the uniqueness and importance of this conference (Table ) .…”