Cardiopulmonary Bypass, Congenital Heart Defect, Inflammation, Inflammatory Response, Low Cardiac Output Syndrome
Conditions
Brief summary
This study evaluates the effect of heart-lung bypass on babies undergoing cardiac surgery. The investigators want to learn more about the inflammation that exposure to bypass creates in the body by studying markers of inflammation and cell injury in the bloodstream. Additionally, the investigators want to examine if these markers can predict which babies develop post-surgical complications. The hypothesis is that babies who undergo bypass will have higher levels of these markers than babies not exposed to bypass and that these markers will correlate with how the baby does clinically after surgery. This study will evaluate markers via blood sampling in babies with congenital heart disease who do not undergo cardiac surgery, those that undergo surgery without bypass, and those that undergo surgery with bypass. The overall goal is that this study will lead to useful biomarkers and lay the groundwork for future novel therapies aimed at improving outcomes for babies who require heart-lung bypass.
Detailed description
This is a minimal risk observational study looking at markers of inflammation and cell injury in the bloodstream of babies with congenital heart disease, with a particular emphasis on whether these markers can predict low cardiac output syndrome in infants who undergo heart-lung bypass. Low cardiac output syndrome is a common postoperative complication marked by poor blood flow to the body affecting nearly 1/3 of infants post-bypass and is associated with significant morbidity and mortality. Babies not requiring surgery will serve as the control group. Infants in group 1 will have 0.5 ml of blood drawn prior to discharge. This will be scavenged from the laboratory when possible. Infants in groups 2 and 3 will require serial blood draws over peri-operative time points each in the volume of 0.5 ml. Group 2: T0 = Before surgery (in the OR) T1 = After chest closure or end of case (in the OR) T2 = On admission to the pediatric intensive care unit T3 = Timed 4-6 hours after the time of admission T4 = Timed 12 hours (+/- 1 hour) after the time of admission T5 = Timed 24 hours (+/-1 hour) after the time of admission Group 3: T0 =Pre-cardiopulmonary bypass to be obtained in the operating room just prior to surgery T1 = After going on bypass (but prior to modified ultrafiltration) T2 = After modified ultrafiltration T3 = On admission to the pediatric intensive care unit T4 = Timed 4-6 hours after the time of admission T5 = Timed 12 hours (+/- 1 hour) after the time of admission T6 = Timed 24 hours (+/-1 hour) after the time of admission
Interventions
PROCEDURESingle blood draw
One blood draw of 0.5 ml volume prior to discharge
PROCEDUREMultiple blood draws
Blood draw at 6 peri-operative time points.
Sponsors
University of Oklahoma
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 6 Months
Healthy volunteers
No
Inclusion criteria
* Infants \< 6 months of age * Born at ≥ 36 weeks gestational age * Birth weight ≥ 2.5 kilograms * Postnatally confirmed congenital heart disease by echocardiogram
Exclusion criteria
* Requiring ≥ 2 vasopressors prior to surgery * Preoperative proven sepsis within one week of surgery * Prior surgery within one week of cardiac repair (except PA banding which is not excluded) * Cardiac catheterization within one week of surgery * Significant extra-cardiac anomalies that may impair organ function
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Biomarker levels and their relationship to LCOS | Baseline level and described time points over the first twenty-four hours postoperatively | Changes in markers of inflammation and cell injury (histones, IL-6, etc.) and correlation with patients who develop low cardiac output syndrome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of mechanical ventilation | Participants will be followed throughout hospital course, maximum length of follow-up one year | Number of days on mechanical ventilation following day of surgery until the point of extubation |
| Acute kidney injury | Participants will be followed for the first twenty four hours postoperatively | Doubling of creatinine in first twenty four hours compared to preoperative levels |
| Extracorporeal membrane oxygenation (ECMO) | First 48 hours postoperatively | Whether or not patient requires ECMO cannulation |
| ICU length of stay | Participants will be followed throughout PICU/CVICU stay, maximum length of follow-up one year | Number of days requiring pediatric/cardiac intensive care unit following day of surgery |
| Change in level of inflammatory response | Baseline, up to 24 hours | Changes in markers of inflammation and cell injury (IL-6, IL-8, etc.) in the peri-operative period (prior to surgery up to 24 hours postop) |
| Mortality risk | PIM-2 calculated within one hour of admission to PICU and PRISM-3 calculated at 12 and 24 hours after PICU admission | Pediatric risk of mortality-3 scale (PRISM-3) and pediatric index of mortality (PIM-2) |
| Mortality | Participants will be followed throughout hospital course, maximum length of follow-up one year | Any type of death that occurs during patient's hospitalization |
| Low cardiac output syndrome | Assessed at 48 hours postoperatively | At least two of the following criteria at any post-operative time point within the first twenty four hours: (a) prolonged cap refill \>3 sec, SBP \<5th %ile for age and gender, low UOP \<1 cc/kg/hr for at least 6 hr not responsive to diuretics, persistently elevated arterial lactate \>2 and metabolic acidosis defined as an increase in the base deficit of \>4, inotropic score \>20, cardiac arrest within 48 hr after surgery, or the need for extracorporeal membrane oxygenation (ECMO) for hemodynamic instability within 48 hours postop |
| Hospital length of stay | Participants will be followed throughout entire hospital course, maximum length of follow-up one year | Number of hospital days patient requires following the day of surgery |
Countries
United States
Outcome results
None listed