The effects of cardiopulmonary bypass temperature on inflammatory response following cardiopulmonary bypass

• Published in: European journal of cardio-thoracic surgery 1999-11, Vol.16 (5), p.540-545
• Main Authors: Birdi, I., Caputo, M., Underwood, M., Bryan, A.J., Angelini, G.D.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; CD3 Complex - analysis; Chi-Square Distribution; Coronary artery surgery; Coronary Disease - surgery; Elective Surgical Procedures; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Humans; Hypothermia, Induced; Immunoglobulin G - analysis; Inflammation - diagnosis; Inflammation - etiology; Inflammation - prevention & control; Inflammation Mediators - analysis; Inflammatory mediators; Interleukin-8 - analysis; Leukocyte Count; Leukocyte Elastase - blood; Male; Medical sciences; Middle Aged; Postoperative Care - methods; Prospective Studies; Statistics, Nonparametric; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(99)00301-2

Objectives: The inflammatory response to cardiopulmonary bypass is believed to play an important role in end organ dysfunction after open heart surgery and may be more profound after normothermic systemic perfusion. The aim of the present study was to investigate the effects of cardiopulmonary bypass temperature on the production of markers of inflammatory activity after coronary artery surgery. Methods: Forty-five low risk patients undergoing elective coronary artery surgery were prospectively randomized into three groups: hypothermia (28°C, n = 15), moderate hypothermia (32°C, n = 15), and normothermia (37°C, n = 15). All patients received cold antegrade crystalloid cardioplegia and topical myocardial cooling with saline at 4°C. Serum samples were collected for the estimation of neutrophil elastase, interleukin 8, C3d, and IgG under ice preoperatively, 5min after heparinisation, 30min following start of CPB, at the end of CPB, 5min after protamine administration, and 4, 12 and 24h postoperatively. Results: Patients were similar with regard to preoperative and intraoperative characteristics (age, sex, severity of symptoms, number of grafts performed, aortic cross clamp time, cardiopulmonary bypass time). Neutrophil elastase concentration increased markedly as early as 30min after the onset of cardiopulmonary bypass and peaked 5min after protamine administration. Levels were not significantly different between the three groups. A similar finding was apparent for C3d release. Interleukin 8 concentrations also demonstrated a considerable increase related to cardiopulmonary bypass in all groups, but there was a significantly more rapid decline in interleukin 8 concentrations in the normothermic group in the postoperative period. Eluted IgG fraction showed a much earlier peak concentration than the other markers, occurring within 30min of the start of cardiopulmonary bypass. Levels reached a plateau, before declining soon after the end of bypass and remained higher than preoperative values at 24h. There was no difference between the three groups. The cumulative release of all markers was calculated from the concentration–time curves, and was not statistically different between groups. Conclusion: Normothermic systemic perfusion was not shown to produce a more profound inflammatory response compared to hypothermic and moderately hypothermic cardiopulmonary bypass.