A Single-Center Analysis of Methylprednisolone Use during Pediatric Cardiopulmonary Bypass

Abstract

Cardiac surgery with the use of cardiopulmonary bypass (CPB) is known to induce an inflammatory response in patients. This response may be even more pronounced in pediatric patients given their small body size compared to adults. Several interventions have been instituted in an effort to attenuate this response, including the use of corticosteroids in the pump prime. However, the clinical effectiveness and potential harmful effects of steroid use have been the source of recent debate. Therefore, our institution made the decision to evaluate the use of methylprednisolone in our CPB prime. This evaluation was performed as a formal quality improvement project at The Children's Hospital of Philadelphia. Methylprednisolone was eliminated from the CPB prime for 6 months. At the end of this time period, The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate clinical outcomes of patients (n = 222). These outcomes were then compared to patients operated on during the 6 months prior to elimination of methylprednisolone (n = 303). No significant clinical benefit was identified in the group of patients who received methylprednisolone. When compared to the group who did not receive methylprednisolone, significantly more patients in the steroids group had a postoperative wound infection (p = .037) or respiratory failure requiring tracheostomy ( p = .035). No other differences in clinical outcomes were identified between the two groups. No significant differences in clinical outcomes were identified between neonates who received methylprednisolone (n = 55) and neonates who did not receive steroids (n = 58). Due to the lack of clinical benefit seen with its use, as well as its potential contribution to the incidence of wound infection, methylprednisolone continues to be excluded from the CPB prime at our institution. Methylprednisolone is still given intraoperatively at the request of the attending anesthesiologist and on bypass during orthotopic transplant procedures according to institutional protocol.

Keywords: cardiopulmonary bypass; inflammatory response; methylprednisolone; outcomes; pediatric.