SUPERIORITY OF CENTRIFUGAL PUMP OVER ROLLER-PUMP IN PEDIATRIC CARDIAC-SURGERY - PROSPECTIVE RANDOMIZED TRIAL

Objective: The merits of centrifugal pump in adult cardiopulmonary byp ass are well established. This study compares the effects of the Medtr onic Biomedicus centrifugal pump with conventionally used roller pump in routine cardiopulmonary bypass in infants and children. Methods: Be tween June 1996 and March 1997, 42 children (aged 2 days-13 years) und ergoing elective cardiac surgery were assigned to either centrifugal o r roller pump bypass. The following variables were studied: haemolysis (haematocrit, free plasma haemoglobin, haptoglobins), platelet activi ty (platelet counts, Beta-thromboglobulin), leukocyte count, cytokine release (IL-2, IL-6, IL-8), complement activation (C3a and C5a), blood and blood product requirements, urine output on bypass, post-operativ e blood urea, duration of ventilation, intensive care and hospital sta y. Results: Age, weight, disease complexity, duration of bypass, and a number of other variables were comparable in the two groups. The cent rifugal pump resulted in lower plasma free haemoglobin (mean +/- SD, 5 0 +/- 23 vs. 72 +/- 35 mg/dl, P < 0.01), higher platelet count (133.1 +/- 34.8 vs. 63.5 +/- 29.6 x 10(9)/l, P < 0.01), less platelet activat ion (beta-TG 1253 +/- 633 vs. 1657 +/- 677 ng/ml; P < 0.05), less cyto kine release (IL-6 329 +/- 57 vs. 392 +/- 59 pg/ml; P < 0.05), and red uced levels of C3a (4822 +/- 274 vs. 5933 +/- 393 ng/ml, P < 0.01). Di fferences were detected in favour of the centrifugal pump in urine out put on bypass (4.1 +/- 0.5 vs. 2.3 +/- 1.9 ml/kg per h, P < 0.01), pos t-operative maximal urea (6.5 +/- 3.1 vs. 10.2 +/- 6.7 mmol/l, P < 0.0 2), ventilation time (18.9 +/- 6.5 vs. 56.5 +/- 51.7 h, P < 0.01), dur ation of intensive care (1.4 +/- 0.79 vs. 3.33 +/- 2.8 days, P < 0.05) and hospital stay (5.7 +/- 1.4 vs. 15.75 +/- 23.9 days, P < 0.01), bu t not in blood and blood product requirements (RCC: 11.26 +/- 4.6 vs. 10.77 +/- 4.2 ml/kg per 24 h, P > 0.05). Conclusion: The centrifugal p ump as compared to roller pump results in less blood trauma, reduced p latelet activation and less pronounced inflammatory response. There is also an improved renal response during and after bypass. This is tran slated clinically into reduced requirement for ventilation, shorter in tensive care and hospital stays. These results strongly favour the use of centrifugal pump in routine paediatric cardiac surgery. (C) 1998 E lsevier Science B.V. All rights reserved.