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Neutrophils and platelets accumulate in the heart, lungs, and kidneys after cardiopulmonary bypass in neonatal pigs

Brix-Christensen, Vibeke MD; Tønnesen, Else DMSc; Hjortdal, Vibeke Elisabeth DMSc; Chew, Michelle MBBS; Flø, Christian Dsci; Marqversen, Jørgen Dscpharm; Hansen, Joachim Frølund; Andersen, Niels Trolle MSc; Ravn, Hanne Berg MD

LABORATORY INVESTIGATIONS
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Objective  Cardiac surgery with cardiopulmonary bypass elicits a systemic inflammatory response. An exaggerated response is associated with organ dysfunction and increased morbidity and mortality.

Design  The aim of the present study was to investigate whether the cardiopulmonary bypass procedure in itself results in accumulation of isotope-labeled platelets, polymorphonuclear neutrophils, and fibrinogen at organ levels in neonatal pigs and to monitor changes in organ function.

Setting  Pediatric cardiopulmonary bypass setup with 60 mins of aortic cross-clamp time and 120 mins of hypothermic cardiopulmonary bypass time.

Subjects  Thirty piglets were allocated to sternotomy alone (sham group, n = 15) or to sternotomy and cardiopulmonary bypass (n = 15).

Measurements and Main Results  Isotope-labeled autologous polymorphonuclear neutrophils, platelets, and commercially available fibrinogen were infused, and the specific accumulation at organ level was measured in a gamma counter 4 hrs after termination of cardiopulmonary bypass. Concomitant changes in oxygenation index and cardiac output were registered. Animals exposed to cardiopulmonary bypass showed a significantly higher technetium-99m-polymorphonuclear neutrophil accumulation in the lungs and kidneys, whereas indium-111-platelets accumulated in the heart and kidneys compared with the sham group. There was a significantly larger increase in oxygenation index and significantly larger decrease in cardiac output between the pre- and postcardiopulmonary bypass period in the cardiopulmonary bypass group compared with the sham group.

Conclusions  The cardiopulmonary bypass procedure without cardiac surgery elicits organ dysfunction in terms of impaired respiratory and hemodynamic function. Platelets and polymorphonuclear neutrophils were entrapped in the heart, lungs, and kidneys of cardiopulmonary bypass animals, indicating that cell accumulation may contribute to the developing organ dysfunction.

From the Departments of Anaesthesiology (VB-C, ET, MC, HBR), Thoracic and Cardiovascular Surgery (VEH), Nuclear Medicine (CF, JM), and the Institute of Experimental Clinical Research (JFH), Aarhus University Hospital, Aarhus, Denmark; and the Department of Biostatistics (NTA), Aarhus University, Aarhus, Denmark.

Supported, in part, by grants from Aarhus University.

Address requests for reprints to: Vibeke Brix-Christensen, MD, Department of Anaesthesiology and Intensive Care, Aarhus Municipal Hospital, Nørrebrogade, 8000 Aarhus C, Denmark; E-mail: brixchr@dadlnet.dk

This study demonstrates that the cardiopulmonary bypass procedure without cardiac surgery induces accumulation of polymorphonuclear neutrophils in the lung and kidneys while platelets accumulate in the heart and kidneys.

© 2002 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins