Document Detail


The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants.
MedLine Citation:
PMID:  14688685     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We hypothesized that cognitive impairment and hemodynamic instability after infant cardiac surgery with cardiopulmonary bypass might be exacerbated by hemodilution. METHODS: In a single-center randomized trial with blinded assessment of outcomes, we compared use of 2 hemodilution protocols during hypothermic cardiopulmonary bypass with infant cardiac surgery. The primary perioperative end point was lowest cardiac index in the first 24 hours postoperatively, and primary end points at age 1 year were scores on the Psychomotor Development Index and Mental Developmental Index of the Bayley Scales. RESULTS: Among 147 subjects, 74 were assigned to the lower-hematocrit strategy (21.5% +/- 2.9%, mean +/- SD at onset of low-flow bypass) and 73 to the higher-hematocrit strategy (27.8% +/- 3.2%). In intent-to-treat analyses the lower-hematocrit group had lower nadirs of cardiac index (P =.02), higher serum lactate levels 60 minutes after cardiopulmonary bypass (P =.03), and a greater percentage increase in total body water on the first postoperative day (P =.006). Blood product use and adverse events were similar in the 2 groups. At age 1 year (113 children), the lower-hematocrit group had worse scores on the Psychomotor Development Index (81.9 +/- 15.7 vs 89.7 +/- 14.7, P =.008), as well as more Psychomotor Development Index scores at least 2 SDs below the population mean (16/56 [29%] vs 5/53 [9%], P =.01). The groups had similar Mental Developmental Index scores and findings on neurologic examination. Inferences using hematocrit as a continuous variable were similar to those based on intent-to-treat analyses. CONCLUSIONS: Hemodilution to a hematocrit level in wide use for cardiopulmonary bypass and thought to be safe is associated with adverse perioperative and developmental outcomes in infants.
Authors:
Richard A Jonas; David Wypij; Stephen J Roth; David C Bellinger; Karen J Visconti; Adre J du Plessis; Howard Goodkin; Peter C Laussen; David M Farrell; Jodi Bartlett; Ellen McGrath; Leonard J Rappaport; Emile A Bacha; Joseph M Forbess; Pedro J del Nido; John E Mayer; Jane W Newburger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  126     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-22     Completed Date:  2004-01-22     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1765-74     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Children's Hospital Boston, MA 02115, USA. Richard.Jonas@tch.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures*
Cardiopulmonary Bypass* / adverse effects
Developmental Disabilities / diagnosis,  etiology*
Heart Defects, Congenital / surgery
Hematocrit
Hemodilution / adverse effects*
Humans
Hypothermia, Induced* / adverse effects
Infant
Neuropsychological Tests
Prospective Studies
Grant Support
ID/Acronym/Agency:
HL 063411/HL/NHLBI NIH HHS; RR02172/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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