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Investigation of myocardial protection during pediatric CPB: Practical experience in 100 Chinese hospitals
Peiyao Zhang1, Jinping Liu1, Yuanyuan Tong1
1State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Pediatric cardiopulmonary bypass (CPB) myocardial protection in China lacks uniform standards for cardioplegia type and dosage. Further research is needed to establish evidence-based guidelines for effective myocardial protection strategies in pediatric heart surgery.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Cardiopulmonary Bypass
Background:
- Myocardial protection strategies are crucial in pediatric congenital heart surgeries.
- Limited data exists on current practices in China regarding myocardial protection during pediatric cardiopulmonary bypass (CPB).
Purpose of the Study:
- To investigate current myocardial protection strategies employed in pediatric CPB across China.
- To identify variations in cardioplegia use, staffing, and hypothermia maintenance.
Main Methods:
- Online questionnaires distributed to 100 hospitals in 27 Chinese provinces.
- Data collected on hospital volume, perfusionist staffing, cardioplegia types, dosages, and cooling methods.
Main Results:
- Significant variation in annual pediatric cardiovascular surgery volume.
- While 91% believed two perfusionists are necessary, only 64% met this.
- Crystalloid cardioplegia (HTK, St. Thomas) was more common than blood-based.
- Del Nido and St. Thomas blood-based cardioplegia were most popular.
- Dosages and hypothermia maintenance (ice buckets in 75%) lacked standardization.
Conclusions:
- Myocardial protection during pediatric CPB relies on cardioplegia-induced arrest and hypothermia.
- Lack of standardized protocols for cardioplegia type and dosage necessitates further investigation.
- Multicenter randomized controlled trials are essential to develop evidence-based guidelines for pediatric CPB myocardial protection.
Abstract:
Many measures have been proposed for myocardial protection in pediatric congenital heart surgeries, but little data is available for China. This study investigates myocardial protection strategies in pediatric cardiopulmonary bypass (CPB) throughout China. Online questionnaires were delivered to 100 hospitals in 27 provinces. The number of yearly on-pump pediatric cardiovascular surgeries in these hospitals varied greatly. About 91.0% of respondents believe that each surgery should have at least two perfusionists, while only 64.0% of hospitals actually met this requirement. For pediatric patients, crystalloid cardioplegia was more prevalent than blood-based cardioplegia. Histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid solution were dominant among crystalloid cardioplegia. Del Nido cardioplegia and St. Thomas blood-based cardioplegia ranked the top two in the popularity of blood-based cardioplegia. Dosages varied among different kinds of cardioplegia. In the choice of different cardioplegia, perfusionists mainly focused on myocardial protective effect and cost. Hypothermia of cardioplegia solution was maintained by ice buckets in 3/4 of the hospitals in this survey. In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.
