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Refraining from Packed Red Blood Cells in Cardiopulmonary Bypass Priming as a Method of Neuroprotection in Pediatric
Artem A Ivkin1, Evgeny Grigoriev1, Anna V Sinitskaya1
1Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia.
Insights
Avoiding packed red blood cells (PRBCs) in priming solutions during congenital heart defect (CHD) surgeries using cardiopulmonary bypass (CPB) is safe and effective for preventing postoperative brain injury in children. This strategy reduces specific brain injury markers post-surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Neuroprotection Strategies
- Cardiopulmonary Bypass
Background:
- Congenital heart defect (CHD) surgeries often involve cardiopulmonary bypass (CPB), posing risks to the pediatric brain.
- Limited research exists on effective brain protection methods during pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the impact of omitting packed red blood cells (PRBCs) from priming solutions on preventing postoperative brain injury in children undergoing CHD surgery with CPB.
Main Methods:
- 40 children undergoing CHD closure with CPB were studied.
- Patients were divided into groups based on PRBC use in priming solutions.
- Brain injury assessed via serum markers (S100β, NSE, GFAP) and Cornell Assessment of Pediatric Delirium.
Main Results:
- No significant differences in postoperative indicators or organ dysfunction between groups.
- Higher concentrations of brain injury markers (S100β, NSE, GFAP) were observed in the PRBC transfusion group post-CPB.
- GFAP levels remained elevated in the transfusion group 16 hours post-surgery.
Conclusions:
- Omitting PRBC transfusions in CPB priming solutions is a safe and effective strategy for brain injury prevention in pediatric CHD surgery.
- This approach demonstrates successful neuroprotection during CPB.
Abstract:
Congenital heart defect (CHD) surgeries are performed with cardiopulmonary bypass (CPB) and are complicated by several factors that affect the child's brain. However, to date, the number of studies on brain protection in cardiac surgery remains small. The aim of this study was to assess the impact of refraining from using packed red blood cells (PRBCs) in priming solutions in children with congenital defects (CHDs) who require surgical interventions using CPB to prevent brain injury in the postoperative period.
Material And Methods:
This study included 40 children, and the mean age was 14 (12-22.5) months and the mean weight was 8.8 (7.25-11) kg. All patients underwent CHD closure using CPB. The patients were divided into two groups depending on the use of PRBCs in the priming solution. Brain injury was assessed using three specific blood serum markers, namely S100 calcium-binding protein β (S100β), neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) before surgery, after the completion of CPB and 16 h after surgery (first, second and third control points). Markers of systemic inflammatory response were also analyzed, including interleukin-1, -6, -10 and tumor necrosis factor alpha (TNF-α). A clinical assessment of brain injury was carried out using a valid, rapid, observational tool for screening delirium in children of this age group, i.e., "Cornell Assessment of Pediatric Delirium".
Results:
Factors of the intra- and postoperative period were analyzed, such as hemoglobin levels, oxygen delivery (cerebral tissue oxygenation, blood lactate level and venous oxygen saturation) and indicators of organ dysfunction (creatinine, urea, bilirubin levels, duration of CPB and length of stay in the ICU). Following the procedure, there were no significant differences between the groups and all indicators were within the reference values, thus demonstrating the safety of CHD closure without transfusion. Moreover, the highest level of specific markers of brain injury were noted immediately after the completion of CPB in both groups. The concentration of all three markers was significantly higher in the group with transfusion after the completion of CPB. Moreover, GFAP levels were higher in the transfusion group and 16 h after surgery.
Conclusions:
The results of the study show the safety and effectiveness of brain injury prevention strategies that consist of not conducting PRBC transfusion.
