Artem IvkinResearch Institute for Complex Issues of Cardiovascular Diseases, Russian Federation
Title: Transfusion-free anesthetic management for cerebro-protection in cardiac surgery in children
Aim: To study the effect of red blood cells transfusion on the development of cerebral damage during the surgical correction of congenital heart defects with cardiopulmonary bypass (CPB) in children.
Methods: 78 children aged 1 to 78 months and weighing from 3.3 to 21.5 kg referred to open-heart surgery were recruited in a prospective study. All patients underwent surgical correction of an atrial or ventricular septal defect with CPB. Markers of cerebral damage (protein S-100-ß, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP)) and systemic inflammatory response syndrome (SIRS) (interleukins 1 (ILb-1), 6 (IL-6), 10 (IL-10) and tumor necrosis factor alpha (TNF-?)). Blood sampling for the study of markers was carried out at three control points: 1 - before the start of surgery, 2-immediately after the completion of EC, 3 - 16 hours after the completion of the operation.
Results: All patients were divided into two groups: group 1 - without transfusion and group 2 - with the use of red blood cells. The concentration of all markers of cerebral damage was significantly higher in the transfusion group at the 2nd control point: the concentration of IL-1b and TNF-? were statistically significantly higher among patients who received transfusion at the 2nd control point, while the concentrations of IL-6 and IL-10 markers were noted as higher with the proper level of statistical significance among patients of group 2 at the point 16 hours after the operation. In addition, significant correlations were found between markers of cerebral damage and SIRS, the strongest of which was the relationship between NSE and TNF-? at the 3rd control point - Rho = 0.43 (p = 0.0001). In addition, there was a correlation between the S-100-ß protein and transfusion volume at the second (Rho = 0.48 p = 0.00065) and third control points (Rho = 0.36 p = 0.01330).
Conclusions: The strategy of avoiding the use of red blood cells in the correction of septal heart defects in children with cardiopulmonary bypass is safe and effective in terms of preventing cerebral damage.
Artem Ivkin is researcher and an anesthesiologist at the Research Institute. He graduated from the university in 2016, work experience in anesthesiology for 6 years. He began to deal with the problem of SIRS, cerebral injury and postoperative delirium in children with the correction of congenital heart defects at the university, since 2014. He has 25 publications with the results of his research, as well as two registered patents. His publication h-index is 3. He is lecturer at the Medical University.