Phentolamine On Cardiopulmonary Bypass Causes Effective Cooling And Rewarming In Infants At The Cost Of Post-Operative Lactic Acidosis And Higher Inotrope Requirement
Manan H. Desai1, Nicolle Ceneri, MD1, Jessica Klube1, Mark Nuszkowski1, Andrea Stough1, Eleanor Gerhard, MD1, David Zurakowski2, Karthik Ramakrishnan1.
1Children's National Medical Centre, Washington, DC, USA, 2Boston Children's Hospital, Boston, MA, USA.
Objective: Phentolamine is a vasodilator during hypothermic cardiopulmonary bypass(CPB) to achieve uniform cooling. However, its effect on end organ perfusion is not known. Our aim was to compare the surrogates of end organ perfusion in patients receiving phentolamine on CPB versus those that did not. Method: A review of 560 infants who underwent congenital cardiac surgery on CPB between January 2010 and December 2016 and required at least moderate hypothermia (<25°C) was performed. The patients were divided into group A (received phentolamine during cooling on CPB) and group B (did not receive phentolamine during cooling on CPB) during initiation of cooling. The end points of interest were rate of cooling and rewarming, serum lactate levels on CPB, and in the early post-operative period and post-operative inotrope score. Results: There 261 patients in group A versus 299 patients in group B. The duration of cooling and rewarming were significantly lower in group (P-value<0.001) compared to group B. Serum lactate on CPB, immediate post-CPB and peak post-operative lactate 48 hours post-operatively were significantly higher in group A versus group B (P-value<0.001). The inotrope score was significantly higher in group A (p<0.001) (Table 1). Conclusion: Phentolamine on CPB in infants decreases the duration of cooling and rewarming but the vasodilatory effects leads to suboptimal end-organ perfusion.
| Variable | Group AMedian (IQR) | Group BMedian (IQR) | p-value |
| Serum Lactate on CPB | 4.2 (2.5, 5.7) | 2.1 (1.7, 3.1 | <0.001 |
| Post CPB Lactate | 4.6 (2.9, 6.5) | 2.1 (1.6, 3.2) | <0.001 |
| Post 48 hour peak lactate | 5.4 (2.8, 9.3) | 2 (1.4, 3.2) | <0.001 |
| Inotrope score | 8.5 (5, 12.5) | 5 (5, 10) | <0.001 |
| Rate of cooling | 0.48 (0.27, 0.83) | 0.23 (0.16, 0.4) | <0.001 |
| Rate of rewarming | 0.51 (0.36, 0.65) | 0.3 (0.21, 0.41) | <0.001 |
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