Aprotinin in deep hypothermic circulatory arrest

Area of Science:

• Cardiothoracic Surgery
• Pharmacology
• Critical Care Medicine

Background:

• Early use of aprotinin in deep hypothermic circulatory arrest (DHCA) raised safety concerns.
• Limited understanding of interactions between hypothermia, stasis, and aprotinin exists.
• Concerns regarding aprotinin's safety in DHCA may stem from inadequate heparinization in reported series.

Purpose of the Study:

• To evaluate the safety and efficacy of aprotinin in patients undergoing DHCA.
• To clarify the potential risks and benefits of aprotinin use in DHCA.
• To provide evidence-based recommendations for aprotinin use in DHCA.

Main Methods:

• Review of existing clinical data and mechanistic considerations.
• Analysis of prospective, randomized studies on aprotinin in DHCA.
• Comparison of outcomes in patients with adequate versus inadequate heparinization.

Main Results:

• No evidence suggests aprotinin is inherently more hazardous in DHCA.
• Excessive adverse events were linked to questionable heparinization adequacy.
• A prospective, randomized series demonstrated significant reductions in blood loss and transfusion needs with aprotinin.

Conclusions:

• Aprotinin's use in DHCA is not associated with unusual hazards when adequate heparinization is maintained.
• Benefits, such as reduced bleeding, are demonstrated in randomized trials.
• Aprotinin use in DHCA should follow the same clinical considerations as in other cardiothoracic procedures.