High-Exchange Ultrafiltration to Enhance Recovery After Pediatric Cardiac Surgery: The ULTRA Randomized Controlled...

Area of Science:

• Cardiovascular Surgery
• Pediatric Critical Care
• Inflammation Research

Background:

• Pediatric cardiac surgery utilizing cardiopulmonary bypass (CPB) is frequently linked to systemic inflammation.
• Investigating novel strategies to mitigate this inflammatory response is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the clinical immunomodulatory effect of continuous high-exchange ultrafiltration during CPB in pediatric patients.
• To determine if high-exchange ultrafiltration impacts post-operative recovery and inflammatory markers.

Main Methods:

• A single-center, double-blinded trial randomized pediatric patients (<15 kg) undergoing cardiac surgery to either high-exchange (H-SBUF, 60 ml/kg/hr) or low-exchange (L-SBUF, 6 ml/kg/hr) subzero-balance ultrafiltration during CPB.
• The primary outcome was the peak post-operative vasoactive-ventilation-renal (VVR) score, with secondary outcomes including acute kidney injury, low cardiac output syndrome, and inflammatory mediator levels.

Main Results:

• No significant difference was observed in the primary outcome (peak VVR score) between the H-SBUF and L-SBUF groups (p = 0.67).
• Secondary clinical outcomes such as acute kidney injury, low cardiac output syndrome, ventilation time, inotrope use, and length of stay were similar between groups.
• The H-SBUF group showed a higher fold change for IL-1α, P-selectin, and VCAM-1, but thirty-six other inflammatory mediators did not differ significantly.

Conclusions:

• Continuous high-exchange subzero-balance ultrafiltration during CPB did not reduce peak VVR scores in pediatric cardiac surgery patients compared to low-exchange ultrafiltration.
• No significant differences in secondary clinical outcomes or the overall immunologic profile were found between the high- and low-exchange ultrafiltration groups.