Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Eur J Cardiothorac Surg. 2023 Apr 3;63(4). doi: 10.1093/ejcts/ezad041.
Intermittent cold blood cardioplegia is commonly used in children, whereas intermittent warm blood cardioplegia is widely used in adults. We aimed to compare clinical and biochemical outcomes with these 2 methods.
A single-centre, randomized controlled trial was conducted to compare the effectiveness of warm (≥34°C) versus cold (4-6°C) antegrade cardioplegia in children. The primary outcome was cardiac troponin T over the 1st 48 postoperative hours. Intensive care teams were blinded to group allocation. Outcomes were compared by intention-to-treat using linear mixed-effects, logistic or Cox regression.
97 participants with median age of 1.2 years were randomized (49 to warm, 48 to cold cardioplegia); 59 participants (61%) had a risk-adjusted congenital heart surgery score of 3 or above. There were no deaths and 92 participants were followed to 3-months. Troponin release was similar in both groups [geometric mean ratio 1.07; 95% confidence interval (CI) 0.79-1.44; P = 0.66], as were other cardiac function measures (echocardiography, arterial and venous blood gases, vasoactive-inotrope score, arrhythmias). Intensive care stay was on average 14.6 h longer in the warm group (hazard ratio 0.52; 95% CI 0.34-0.79; P = 0.003), with a trend towards longer overall hospital stays (hazard ratio 0.66; 95% CI 0.43-1.02; P = 0.060) compared with the cold group. This could be related to more unplanned reoperations on bypass in the warm group compared to cold group (3 vs 1).
Warm blood cardioplegia is a safe and reproducible technique but does not provide superior myocardial protection in paediatric heart surgery.
间歇性冷血停搏液在儿童中应用广泛，而间歇性温血停搏液在成人中应用广泛。我们旨在比较这两种方法的临床和生化结果。
一项单中心、随机对照试验比较了温血（≥34°C）与冷血（4-6°C）顺行停搏液在儿童中的效果。主要结局是术后 48 小时内心脏肌钙蛋白 T 的变化。重症监护团队对分组情况设盲。通过意向治疗，采用线性混合效应、逻辑或 Cox 回归比较结果。
97 名中位年龄为 1.2 岁的参与者被随机分配（49 名接受温血停搏液，48 名接受冷血停搏液）；59 名参与者（61%）的风险调整先天性心脏病手术评分≥3 分。无死亡病例，92 名参与者随访至 3 个月。两组的肌钙蛋白释放相似[几何均数比 1.07；95%置信区间（CI）0.79-1.44；P=0.66]，其他心功能指标（超声心动图、动脉和静脉血气、血管活性-正性肌力评分、心律失常）也相似。与冷血组相比，温血组的重症监护时间平均延长 14.6 小时（危险比 0.52；95%CI 0.34-0.79；P=0.003），且整体住院时间有延长趋势（危险比 0.66；95%CI 0.43-1.02；P=0.060）。这可能与温血组比冷血组有更多计划外的体外循环再手术有关（3 例比 1 例）。
温血停搏液是一种安全且可重复的技术，但在儿科心脏手术中并不能提供更好的心肌保护。
