Key result
Study protocol evaluates whether CPB carbon dioxide production index predicts infant hyperlactatemia.
Why the study?
Hyperlactatemia during cardiopulmonary bypass is frequent in infants and linked to morbidity and mortality, but the critical VCO2i threshold in infants is unknown and cannot be extrapolated from adult data.
Does the carbon dioxide production index (VCO2i) during cardiopulmonary bypass predict hyperlactatemia in pediatric patients undergoing congenital cardiac surgery?
Case-Control
No
Does the carbon dioxide production index (VCO2i) during cardiopulmonary bypass predict hyperlactatemia in pediatric patients undergoing congenital cardiac surgery?
This study protocol outlines a nested case-control trial to investigate the association between carbon dioxide production index during cardiopulmonary bypass and hyperlactatemia in pediatric patients.
HL during infant CPB may link to VCO2i thresholds above adult values; leaves open prospective validation before any practice change.
Background Hyperlactatemia (HL) during cardiopulmonary bypass (CPB) is relatively frequent in infants and associates with increased morbidity and mortality. Studies on adults have shown that carbon dioxide production index (VCO 2 i) during CPB is linked to the occurrence of HL, with ‘critical thresholds’ for VCO 2 i reported to be 60 mL/min/m 2 . However, considering infants have a higher metabolic rate and lower tolerance to hypoxia, the critical threshold of VCO 2 i in infants cannot be replied to the existing adults’ standards. The objective of this study is to investigate the association of VCO 2 i during CPB and HL, and explore the critical VCO 2 i threshold during CPB in infants. Methods VCO 2 i predicts hyperlactatemia during cardiopulmonary bypass in pediatric cardiac surgery (pGDP-VCO 2 i) is a nested case-control study. A cohort of consecutive pediatric patients of less than 3 years of age, undergoing congenital cardiac surgeries between May 2021 and December 2023 in West China Hospital will be enrolled. The VCO 2 i levels of each patient will be recorded every 5 min during CPB. The primary outcome is the rate of HL. The infants will be divided into two groups based on the presence or not of HL. Pre- and intraoperative factors will be tested for independent association with HL. Then, we will make an analysis, and the critical value of VCO 2 i will be obtained. The postoperative outcome of patients with or without HL will be compared. Discussion This will be the first trial to investigate the association of VCO 2 i during CPB and HL, and explore the critical VCO 2 i threshold during CPB in pediatrics. The results of this study are expected to lay a foundation for clinical application of goal-directed perfusion (GDP) management strategy, and optimize the perfusion strategy and improve the prognosis of pediatric patients undergoing cardiac surgery. Trial registration Chictr.org.cn, ChiCTR2100044296 on 16 March 2021.
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Zhang et al. (2024) conducted a case-control in Congenital cardiac surgery requiring cardiopulmonary bypass. Carbon dioxide production index (VCO2i) was evaluated on Rate of hyperlactatemia. This study protocol describes a nested case-control trial designed to investigate the association between carbon dioxide production index during cardiopulmonary bypass and hyperlactatemia in infants.
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