Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland.
Department of Clinical Perfusion, Cork University Hospital, Cork, Ireland.
Perfusion. 2022 Oct;37(7):656-667. doi: 10.1177/02676591211014821. Epub 2021 May 13.
Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis.
A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered.
Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences.
This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.
体外循环心脏手术常引起全身炎症反应综合征，进而导致低心排综合征（LCOS）的发生。这两者都会影响发病率和死亡率。本研究对体外循环（CPB）过程中给予气态一氧化氮（gNO）对术后结果的影响进行了系统评价，旨在总结现有证据，评估 CPB 回路中 gNO 的有效性，并突出需要进一步研究的领域，以发展这一假说。
2020 年 5 月，对 Pubmed、Embase、Web of Science 和 Cochrane 图书馆进行了全面检索。仅考虑随机对照试验（RCT）。
共确定了 3 项研究，总计 274 例患者。这些研究在使用的结局指标上存在差异。这些研究表明，这种干预措施可能有助于心脏保护。干预组的心肌肌钙蛋白 I（cTnI）水平显著降低，血管活性正性肌力药评分较低。研究之间存在高度异质性。机械通气时间、重症监护病房住院时间和住院时间的荟萃分析显示无显著差异。
本系统评价探讨了三项初步 RCT 的结果。总体而言，该假说认为 CPB 回路中给予的 NO 可以提供心脏保护，这一研究得到了支持。证据仍存在很大差距，成人和儿科人群均需要进一步进行高质量的研究。
