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Background Bleeding is one of the most common problems affecting children undergoing cardiac surgery on cardiopulmonary bypass. Our aim was to investigate the efficacy and safety of antifibrinolytic agents as well as the safety of various dosing regimens in pediatric cardiac surgery by cardiopulmonary bypass. All studies looking at patients with underlying hematological disorders were excluded. Results Thirty of 209 papers were included, comparing the following drugs versus control: aprotinin n = 14, tranexamic acid n = 12, and epsilon-aminocaproic acid n = 4. Participants in the intervention group varied from 11 to 100, with a large age range and weight range. TXA by 9. 0 mL/kg, EACA by 10. 5 mL/kg, and EACA by 10. 5 mL/kg were all reduced by means 24-hour blood loss compared to control: low to moderate. All agents also reduced 24-hour blood product transfusion.
Source link: https://europepmc.org/article/MED/34633994
Specifically, the aim was to determine which metabolic processes can be reliably interrogated by 1 H MRS on a 3T clinical scanner and to present an initial investigation of brain metabolism during deep hypothermia cardiac arrest surgery and recovery. Methods 14 neonatal pigs underwent CPB surgery, but they were only exposed to 3T MRI scanners for 18°C, 28°C, and 37°C DHCA research under hyperglycemic, euglycemic, and hypoglycemic conditions. Conclusions In vivo 1 H MRS 3T can rapidly quantify subtle metabolic brain changes that had previously been considered impossible to investigate, including brain glucose levels under hypoglycemic conditions, ATP use under hypoglycemic conditions, oxidization of PCr to Cr, and variances in Glu and Gln.
Source link: https://europepmc.org/article/MED/35483967
The aim of this study was to determine the diagnostic value of plasma neutrophil gelatinase-associated lipocalin in adult patients requiring cardiopulmonary bypass after cardiac surgery. Using the Quality Assessment for Diagnostic Accuracy Studies 2 software, the risk of bias was assessed. Using the hierarchical summary receiver operator characteristic curve model, summary results for sensitivity and specificity were estimated for both sensitivity and specificity. Both pair of sensitivity and specificity estimates from each included study was performed by a random-effects meta-analysis. PNGAL had excellent results for the diagnosis of AKI in the defined population when compared to earlier and later time points. In conclusion, the diagnostic value of pNGAL in this clinical setting is inconclusive, and large individual studies of representative populations of cardiac surgery patients using assays that specifically detect NGAL in its monomeric form are required.
Source link: https://europepmc.org/article/MED/35440800
During heart surgery, calcium depletion may occur in children due to various biochemical disorders. The aim of this research was to determine the effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables and clinical outcomes in infants undergoing open-heart surgery. The investigation involved a total of 60 patients with open-heart surgery weighing up to 10 kilograms. The results of two-way repeated measures ANOVA revealed that mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure, mean arterial pressure, mean arterial pH, mean arterial pressure, mean arterial pressure, mean hemoglobin, and mean hemoglobin were all statistically significant, with both control groups being statistically significant. Conclusions The present study found that, unlike systolic pressure, mean diastolic blood pressure decreased, and mean arterial pressure increased significantly.
Source link: https://europepmc.org/article/MED/35416549
Purpose: During cardiopulmonary bypass, core temperature control is vital. We investigated the effectiveness of the transoesophageal echocardiography probe as a core temperature monitor during CPB in this prospective observational study. However, the intra-class correlation of the TOE temperatures with the arterial outlet temperatures was more accurate than the NP temperatures and with less bias. During rewarming, although the NP temperatures lagged behind the arterial outlet temperatures, the TOE probe's results were noticeably higher. The TOE and the arterial outlet temperature readings were similar at 30 minutes of rewarming, but the NP temperatures remained higher than 0. 5 0 C, with significant less bias. During CPB, the TOE probe as an oesophageal temperature monitor is superior to the NP probe as an oesophageal temperature monitor.
Source link: https://europepmc.org/article/PPR/PPR478392
This report also compared the hemostatic characteristics between patients undergoing elective cardiac surgery with CPB and without CPB. Among them, 20 patients with cardiopulmonary bypass were chosen for elective cardiac bypass without cardiopulmonary bypass, 20 patients with cardiopulmonary bypass time less than 90 minutes, and 15 patients were offered with cardiopulmonary bypass time of 90 minutes or more. The difference between post-operative mean hemoglobin and RBC values, WBC and Platelet count on arrival at the intensive care unit at 48 hours and 7 days after surgery was statistically significant in the three groups. Patients with long cardiopulmonary bypass time had demonstrated blood and coagulation abnormalities, which could be reduced if we could shorten the bypass time.
Source link: https://europepmc.org/article/MED/35383769
Objectives This research was conducted to see if a 'protective' ventilation strategy could shorten the postoperative ventilation time and minimize acute lung injury in children with congenital heart disease undergoing heart disease repair with cardiopulmonary bypass. A cohort of patients with CPB under Assist-control ventilation was trialed by Assist-controlled ventilation. Aspirates were measured with clinical and ventilation data as well as lung inflammatory biomarkers. CHD Study We had 140 children with differing CHD. The primary outcome was a postoperative intubation time of more or less than 48 h. No such evidence for the effect of intraoperative ventilation on postoperative intubation time was found, according to estimate 0. 13 [P = 0. 22]. Conclusions Continuous low-tidal/low-frequency mechanical ventilation in CPB is safe and harmless. However, no significant improvements were found in terms of postoperative ventilation time in comparison to non-ventilated patients.
Source link: https://europepmc.org/article/MED/35333340
Background Neonates with a significant congenital heart disease and cardiopulmonary bypass are at risk of brain injury that may result in impaired neurogenesis. This trial is designed to determine if allopurinol administration in CCHD neonates will result in a 20% reduction in moderate to severe ischemic and hemorrhagic brain injury in children under the age of 20. Participants include neonates with a prenatal or postnatal CCHD diagnosis requiring cardiac surgery with CPB in the first four weeks after birth. In all neonates, Allopurinol or mannitol-placebo will be administered intravenously in neonates diagnosed antenatally and 3 doses perioperatively of 20 mg/kg each. Discussion This trial will determine whether allopurinol administered directly after birth and around cardiac surgery reduces moderate/severe ischemic and hemorrhagic brain injury, as well as enhanced cardiac function and neurodevelopment in CCHD neonates.
Source link: https://europepmc.org/article/MED/35197082
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