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Published on: March 27, 2018
Cardioprotection with Intralipid During Coronary Artery Bypass Grafting Surgery on Cardiopulmonary Bypass: A
Nkanyiso Hadebe1,2, Martin Cour1, Aqeela Imamdin1
1Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
Insights
Intralipid did not reduce myocardial ischemia-reperfusion injury (IRI) in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB). This pilot trial found no significant difference in troponin I levels between Intralipid and placebo groups.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) can cause myocardial ischemia-reperfusion injury (IRI).
- Intralipid, a lipid emulsion, has shown potential in experimental and clinical studies to mitigate myocardial IRI.
- This study investigated Intralipid's efficacy in reducing myocardial IRI during CABG procedures.
Purpose of the Study:
- To determine if Intralipid administered at reperfusion can reduce myocardial ischemia-reperfusion injury (IRI) in patients undergoing CABG on CPB.
- To evaluate the effect of Intralipid on cardiac biomarkers and clinical outcomes post-CABG.
Main Methods:
- A randomized, double-blind, pilot trial involving 29 adult patients scheduled for CABG.
- Patients were assigned to receive either Intralipid 20% or Ringer's Lactate 3 minutes before aortic unclamping.
- The primary endpoint was the 72-hour area under the curve (AUC) for troponin I.
Main Results:
- The 72-hour AUC for troponin I did not significantly differ between the Intralipid and control groups (P = 0.804).
- Other assessed outcomes, including troponin I, CK-MB, C-reactive protein, defibrillation needs, extubation time, and length of stay, were similar between groups.
- Twenty-six patients completed the study; two withdrew consent and one was excluded.
Conclusions:
- Intralipid administered at reperfusion did not limit myocardial IRI in patients undergoing CABG on CPB compared to placebo.
- The findings suggest that Intralipid may not be effective in reducing myocardial IRI in this specific clinical setting.
- Further research may be needed to explore alternative strategies for mitigating IRI during CABG.
Purpose:
Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) is associated with myocardial ischemia-reperfusion injury (IRI), which may limit the benefit of the surgery. Both experimental and clinical studies suggest that Intralipid, a lipid emulsion commonly used for parenteral nutrition, can limit myocardial IRI. We therefore aimed to investigate whether Intralipid administered at reperfusion can reduce myocardial IRI in patients undergoing CABG on CPB.
Methods:
We conducted a randomized, double-blind, pilot trial in which 29 adult patients scheduled for CABG were randomly assigned (on a 1:1 basis) to receive either 1.5 ml/kg Intralipid 20% or Ringer's Lactate 3 min before aortic cross unclamping. The primary endpoint was the 72-h area under the curve (AUC) for troponin I.
Results:
Of the 29 patients randomized, 26 were included in the study (two withdrew consent and one was excluded before surgery). The 72-h AUC for troponin I did not significantly differ between the control and Intralipid group (546437 ± 205518 versus 487561 ± 115724 arbitrary units, respectively; P = 0.804). Other outcomes (including 72-h AUC for CK-MB, C-reactive protein, need for defibrillation, time to extubation, length of ICU and hospital stay, and serious adverse events) were similar between the two groups.
Conclusion:
In patients undergoing CABG on CPB, Intralipid did not limit myocardial IRI compared to placebo.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June 2016).
