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Histamine release in paediatric cardiopulmonary bypass--a possible role in the capillary leak syndrome
Insights
Paediatric cardiac surgery patients often have high histamine levels in donor blood primes. This histamine load delivered at the start of perfusion may cause pathological effects in children undergoing heart surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Anesthesiology
- Pharmacology
Background:
- Elevated plasma histamine levels are documented in adults undergoing open-heart surgery.
- Pediatric cardiac surgery utilizes donor blood primes, potentially increasing histamine release before perfusion.
Purpose of the Study:
- To investigate the prevalence and magnitude of elevated histamine levels in prime solutions used in pediatric cardiac surgery.
- To assess the potential impact of histamine load on pediatric patients during cardiac surgical procedures.
Main Methods:
- Analysis of plasma histamine levels in the prime solutions of 40 pediatric cardiac surgery cases.
- Comparison of histamine levels against established pathological thresholds (>1 ng/ml) and previously reported findings.
Main Results:
- Pathologically elevated histamine levels (>1 ng/ml) were detected in 73% (26/37) of prime samples.
- Massively elevated histamine levels (>80 ng/ml) were observed in 22% (9/40) of cases.
- Histamine levels in pediatric primes were substantially higher than those reported in adult studies.
Conclusions:
- Conventional pediatric cardiac surgical practice involves markedly elevated histamine levels in prime solutions for most patients.
- The early delivery of this significant histamine load during perfusion may lead to systemic pathological effects in pediatric cardiac surgery patients.
Abstract:
Recent studies have reported pathologically elevated plasma histamine levels in adult patients during and after open heart surgery. In paediatric practice, the increased use of donor-blood primes might be expected to produce even greater rises in the histamine levels, by creating histamine release in the prime before initial perfusion commences. The present study covered 40 arbitrarily chosen paediatric cases. Pathologically elevated plasma histamine levels (greater than 1 ng/ml) were found in the prime of 26 out of 37 cases (73%). Histamine levels were substantially higher than levels encountered in previously reported studies, and massively elevated prime histamine levels (greater than 80 ng/ml) were encountered in 9 out of the 40 cases (22%). These results suggest that in conventional paediatric cardiac surgical practice, the prime content of histamine is markedly elevated in the majority of patients. The inevitable delivery of this prime histamine load at the onset of perfusion might be expected to produce systemic pathological effects.