Intravenous prostacyclin mitigates inhaled nitric oxide rebound effect: A case control study

Although extracorporeal membrane oxygenation (ECMO) improves oxygenation, p ulmonary vascular resistance may be increased due to endothelial function i mpairment. Inhaled nitric oxide (iNO) is increasingly used for treatment of pulmonary hypertension after surgical repair of congenital heart defects, with or without ECMO. One of the main complications of its application is d eterioration of oxygenation following withdrawal of iNO. To test whether in travenous prostacyclin applied prior to and during iNO withdrawal can mitig ate this rebound effect, we conducted a retrospective case control study. T he rebound effect was defined as a 5% decrease of oxygenation saturation wi thin 4 h after iNO withdrawal. Twelve children suffering from pulmonary hyp ertension (2 after ECMO) and treated with iNO received 10 ng/kg/min prostac yclin intravenously 24 h prior to iNO withdrawal (Group 1). Twelve children treated with iNO (3 after ECMO) who received no prostacyclin prior to iNO withdrawal were matched as controls. The rebound effect occurred in 1 out o f 12 children in Group 1 and in 8 out of 12 children in Group 2 (p = 0.0039 ). We conclude that application of intravenous prostacyclin prior to and du ring iNO withdrawal may be able to mitigate the rebound effect.