PROINFLAMMATORY CYTOKINE RELEASE DURING PEDIATRIC CARDIOPULMONARY BYPASS - INFLUENCE OF CENTRIFUGAL AND ROLLER-PUMPS

Objective: It has been proposed that nonocclusive centrifugal pumps ma y elicit less blood cell trauma and hence a reduced inflammatory respo nse than standard roller pumps. However, there have been no reports de scribing the impact of such pumps on proinflammatory cytokine release in pediatric cohorts. Design: A prospective randomized study was under taken. Setting: A regional cardiothoracic center of a university hospi tal. Participants: Thirty-four pediatric patients undergoing cardiopul monary bypass (CPB) for the correction of complex congenital heart def ects were recruited. Interventions: Either standard twin roller (n = 1 7), or centrifugal vortex (Biopump, Medtronic Biomedicus Inc, MN) (n = 17) blood pumping. Measurements and Main Results: Venous blood was dr awn (1) on induction of anesthesia, (2) 5 minutes on bypass, (3) end o f CPB, (4) 30 minutes post-protamine, (5) 2 hours and (6) 24 hours pos toperation. Neutrophil count, level of plasma leukocyte elastase, term inal complement complex (C5b-9), interleukin-6 (IL-6) and interleukin- 8 (IL-8) were increased during and after CPB compared with the postind uction baseline. C5b-9 levels in both groups peaked at the end of CPB before returning to baseline at 24 hours: (median [range]), 564 (16 to 1,136) ng/mL in centrifugal group versus 508 (0 to 1,128) ng/mL in th e roller group. IL-6 in both groups reached its peak level at 2 hours postprotamine (208 [98 to 411] pg/mL in centrifugal versus 205 [60-327 ] pg/mL in the roller group), before coming hack to baseline at 24 hou rs. Plasma leukocyte elastase and IL-8 reached their maximum level 15 minutes after protamine administration:215 (64 to 375) pg/mL in centri fugal versus 235 (87 to 410) pg/mL in roller group; and 700 (90 to 5,9 25) ng/mL versus 362 (120 to 3,400) ng/mL, respectively. Conclusions: The current study confirms the proinflammatory nature of pediatric CPB surgery, but failed to show a significant advantage of centrifugal pu mping over roller perfusion in terms of the inflammatory response. Cop yright (C) 1997 by W.B. Saunders Company.