Intensive Care Medicine

, Volume 42, Issue 11, pp 1744–1752 | Cite as

Nitric oxide administration during paediatric cardiopulmonary bypass: a randomised controlled trial

  • Christopher James
  • Johnny Millar
  • Stephen Horton
  • Christian Brizard
  • Charlotte Molesworth
  • Warwick Butt
Pediatric Original

Abstract

Purpose

Cardiopulmonary bypass induces an ischaemia–reperfusion injury and systemic inflammatory response, which contributes to low cardiac output syndrome following cardiac surgery. Exogenous nitric oxide during cardiopulmonary bypass has shown potential to ameliorate such injury. We undertook a large randomised controlled trial to investigate the clinical effects of administering nitric oxide to the cardiopulmonary bypass circuit in children.

Methods

After written informed consent, children were randomised to receive 20 ppm nitric oxide to the gas inflow of the cardiopulmonary bypass oxygenator, or standard conduct of bypass.

Results

101 children received nitric oxide and developed low cardiac output syndrome less frequently (15 vs. 31 %, p = 0.007) than the 97 children who did not receive nitric oxide. This effect was most marked in children aged less than 6 weeks of age (20 vs. 52 %, p = 0.012) and in those aged 6 weeks to 2 years (6 vs. 24 %, p = 0.026), who also had significantly reduced ICU length of stay (43 vs. 84 h, p = 0.031). Low cardiac output syndrome was less frequent following more complex surgeries if nitric oxide was administered (17 vs. 48 %, p = 0.018). ECMO was used less often in the nitric oxide group (1 vs. 8 %, p = 0.014).

Conclusions

Delivery of nitric oxide to the oxygenator gas flow during paediatric cardiopulmonary bypass reduced the incidence of low cardiac output syndrome by varying degrees, according to age group and surgery complexity.

Clinical Trial Registration: ACTRN12615001376538.

Keywords

Cardiopulmonary bypass Nitric oxide Low cardiac output syndrome Congenital heart disease 

Notes

Compliance with ethical standards

Funding sources

None.

Conflicts of interest

WB has received payment for educational activities by Ikaria Australia.

Supplementary material

134_2016_4420_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)
134_2016_4420_MOESM2_ESM.tif (93 kb)
Supplementary Figure 1. Time of diagnosis of LCOS

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Department of Intensive CareRoyal Children’s HospitalMelbourneAustralia
  2. 2.Murdoch Children’s Research InstituteMelbourneAustralia
  3. 3.Perfusion DepartmentRoyal Children’s HospitalMelbourneAustralia
  4. 4.Department of Cardiac SurgeryRoyal Children’s HospitalMelbourneAustralia
  5. 5.Department of PaediatricsUniversity of MelbourneMelbourneAustralia

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