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      Respuesta hemodinámica a la circulación extracorpórea con normotermia en la cirugía cardiovascular pediátrica Translated title: Hemodynamic response to extracorporeal circulation with normothermia in pediatric cardiovascular surgery

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          Introducción: El empleo de la normotermia durante la circulación extracorpórea en pediatría fue iniciado por Lecompte en 1995. Objetivo: Evaluar la respuesta hemodinámica con el empleo de la normotermia como método de protección de órganos durante la circulación extracorpórea en niños. Método: Se distribuyeron aleatoriamente 100 pacientes mayores de 30 días. En normotermia (n=45) se utilizó temperatura de 36 0C, hematocrito mayor de 30 % y flujo de perfusión entre 2,8 y 3,5 L/min/m². En hipotermia (n= 55), hematocrito entre 25 y 30 % y flujo de perfusión entre 2,2 y 2,8 L/min/m². Resultados: Ambos grupos fueron homogéneos en edad, peso y riesgo ajustado para los procedimientos quirúrgicos. La respuesta hemodinámica fue significativamente mejor con la normotermia, según valores de ácido láctico, saturación venosa central de oxígeno e índice cardíaco al final de la circulación extracorpórea y a las 8 horas de ingreso en la unidad de cuidados intensivos. Conclusiones: La normotermia durante la circulación extracorpórea en niños es segura y eficaz.

          Translated abstract

          Introduction: The use of normothermia during extracorporeal circulation in Pediatrics was started by Lecompte in 1995. Objective: To assess the hemodynamic response with the use or normothermia as a protection method for organs over the extracorporeal circulation in children. Method: One hundred patients aged over 30 days were randomly distributed. In normothermia (n =45) temperature was of 36ºC, hematocrit more than 30 % and the perfusion flow between 2,2 and 2,8 L/min/m². Results: Both groups were homogenous in age, weight and risk adjusted for surgical procedures. Hemodynamic response was significantly better with normothermia according the lactic acid values, oxygen central venous saturation and heart rate at the end of extracorporeal circulation and at 8 h post-admission in the intensive care unit (ICU). Conclusions: The normothermia in Pediatric cardiovascular surgery with extracorporeal circulation perfusion is sure and efficacy.

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          Most cited references 21

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          Normothermic cardiopulmonary bypass and myocardial cardioplegic protection for neonatal arterial switch operation.

          Hypothermic cardiopulmonary bypass (CPB) associated with cold myocardial protection is commonly used to perform neonatal cardiac surgery. Hypothermia is usually chosen to preserve the brain in case of failure of oxygen delivery whatever it may result from. Nowadays, there is a growing number of evidence demonstrating that hypothermia induces deleterious effects, which may culminate in organ dysfunctions. In 2001, we started a protocol where the heart and the body were no longer cooled, in all the procedures, including the arterial switch operation (ASO), except those with aortic arch reconstruction. Because data on the neonatal arterial switch operation were prospectively gathered in our unit (and included fine biochemical analysis of myocardial damage), we have compared two consecutive populations of arterial switch operation to sort out the impact of normothermic CPB and normothermic cardioplegia. The results show that warm cardiopulmonary bypass associated with warm cardioplegia is feasible for ASO, and that most of the operative data are similar to hypothermic bypass, none are worse. Among the postoperative data, the cardiac troponin I (cTnI) time course showed significantly lower values in the normothermic group after 24 h (4.46 ng ml(-1) vs 6.17 ng ml(-1) (p = 0.027)), time to extubation is improved (32+/-26 h vs 70+/-69 h (p = 0.02)) and there is a trend to reduce the ICU length of stay (3.5+/-1.5 days vs 5.6+/-3.9 days (p = 0.08)), and consequently the cost of surgery. Normothermic cardiopulmonary bypass is feasible for ASO and seems to allow a faster recovery time.
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            Warm pediatric cardiac surgery: European experience.

             Yves Durandy (2010)
            Cold pediatric cardiac surgery has been a dogma for 50 years. However, the beneficial effects of cold perfusion are counterbalanced by the drawbacks of hypothermia. Thus, we propose a major paradigm shift from hypothermic surgery to warm perfusion and intermittent warm blood cardioplegia. This approach gives satisfactory results even with prolonged aortic crossclamp times. The major advantages are reduced time to extubation and shorter intensive care unit stay. Warm pediatric surgery is an anecdotal phenomenon no more; over 10,000 procedures have been carried out in Europe. All types of cardiopathy have been treated, including arterial switch, total pulmonary anomalous venous return, interruption of the aortic arch, and hypoplastic left heart syndrome. Once surgeons decide to shift from hypothermia to normothermia, they never decide to shift back to hypothermia. This fact is evidence of the satisfactory clinical outcome obtained with this technique. The technique and the composition of microplegia is identical in all European centers, the only variable factor being the interval between microplegia injections, which varies from 10 to 25 min. We hope that the increasing interest in pediatric warm surgery will hearten new candidates.
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              What are the best temperature, flow, and hematocrit levels for pediatric cardiopulmonary bypass?

               Antonio Corno (2002)

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Revista Cubana de Anestesiología y Reanimación
                Rev cuba anestesiol reanim
                Editorial Ciencias Médicas (Ciudad de la Habana )
                December 2011
                : 10
                : 3
                : 242-248
                [1 ] Servicio de Cirugía Peru
                [2 ] Servicio de Anestesia
                [3 ] Servicio de Perfusión
                Product Information: website


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