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Impact of minimal invasive extracorporeal circulation on systemic inflammatory response – a randomized trial
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Impact of minimal invasive extracorporeal circulation on systemic inflammatory response – a randomized trial
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Journal Article
Impact of minimal invasive extracorporeal circulation on systemic inflammatory response – a randomized trial
2024
Overview
Background
Extracorporeal circulation causes a systemic inflammatory response, that may cause postoperative haemodynamic instability and end-organ dysfunction. This study aimed to investigate the impact of minimal invasive extracorporeal circulation (MiECC) on the systemic inflammatory response compared with conventional extracorporeal circulation (CECC).
Methods
Patients undergoing coronary artery bypass grafting were randomized to MiECC (
n
= 30) and CECC (
n
= 30). Primary endpoint was tumor necrosis factor-α. Secondary endpoints were other biochemical markers of inflammation (IL1β, IL6 and IL8, C-reactive protein, leukocytes), and markers of inadequate tissue perfusion and tissue damage (lactate dehydrogenase, lactate and creatine kinase-MB). In addition, we registered signs of systemic inflammatory response syndrome, haemodynamic instability, atrial fibrillation, respiratory dysfunction, and infection.
Results
Patients treated with MiECC showed significantly lower levels of tumor necrosis factor-α than CECC during and early after extracorporeal circulation (median: MiECC 3.4 pg/mL; CI 2.2–4.5 vs. CECC 4.6 pg/mL; CI 3.4–5.6;
p
= 0.01). Lower levels of creatine kinase-MB and lactate dehydrogenase suggested less tissue damage. However, we detected no other significant differences in any other markers of inflammation, tissue damage or in any of the clinical outcomes.
Conclusions
Lower levels of TNF-α after MiECC compared with CECC may reflect reduced inflammatory response, although other biochemical markers of inflammation were comparable. Our results suggest better end-organ protection with MiECC compared with CECC. Clinical parameters related to systemic inflammatory response were comparable in this study.
Clinical registration number
NCT03216720.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Coronary Artery Bypass - adverse effects
/ Coronary Artery Bypass - methods
/ Coronary artery bypass grafting
/ Creatine
/ Extracorporeal Circulation - methods
/ Female
/ Humans
/ Kinases
/ Male
/ Medicine
/ Minimal invasive extracorporeal circulation
/ Postoperative Complications - blood
/ Surgeons
/ Surgical apparatus & instruments
/ Systemic inflammatory response
/ Systemic inflammatory response syndrome
/ Systemic Inflammatory Response Syndrome - blood
/ Systemic Inflammatory Response Syndrome - etiology
