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

It is well-established that cardiac surgery with the use of cardiopulmonary bypass (CPB) initiates an inflammatory response in patients (1–8). The full extent of all contributing factors to this process has not been completely elucidated. While surgical and anesthetic factors certainly play a role in this response, the use of CPB appears to exacerbate it (3). Exposure of blood to foreign surfaces, mechanical shear stress, ischemia–reperfusion, hemodilution, blood product transfusion, and hypothermia are specific variables related to CPB that can lead to systemic inflammatory response syndrome (SIRS) postoperatively (1–6). The manifestation of SIRS can vary from mild capillary leak to clinically relevant organ dysfunction (2,4). This response can be even more pronounced in pediatric patients given the greater degree of hemodilution, increased need for blood product transfusion, and more frequent use of hypothermia. Modifications to CPB-specific variables have been performed in an effort to minimize the inflammatory response to bypass. Such interventions include: circuit miniaturization, the use of various ultrafiltration techniques, leukocyte filtration, and the inclusion of corticosteroids (most frequently methylprednisolone) in the CPB prime (2,4–17). Corticosteroids have the ability to attenuate complement activation and pro-inflammatory mediators (interleukin [IL]-1, IL-6, IL-8, leukotrienes, endotoxin, tumor necrosis factor) while augmenting anti-inflammatory mediators (IL-4, IL-10) (4,7–11). Therefore, in its biochemical aspects, methylprednisolone has the ability to decrease the markers of inflammation associated with the use of CPB (6). Recently, however, research has shown no clinical benefit to the perioperative use of methylprednisolone during pediatric cardiac surgery (13–17). Furthermore, several of these studies found that the use of corticosteroids intraoperatively was associated with a greater incidence of infection postoperatively (13,14,17). In their 2012 study, Pasquali et al. (17) also correlated the use of methylprednisolone with an increased length of stay in pediatric patients. Based on this latest data, our institution decided to discontinue the use of methylprednisolone in the CPB prime for 6 months. The permanent removal of steroids from the pump prime was then re-evaluated after an assessment of several clinical outcome variables.