Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass: Randomized Controlled Trial.
J Am Coll Cardiol
; 74(5): 659-668, 2019 08 06.
Article
em En
| MEDLINE
| ID: mdl-31370958
ABSTRACT
BACKGROUND:
The efficacy of intraoperative corticosteroids to improve outcomes following congenital cardiac operations remains controversial.OBJECTIVES:
The purpose of this study was to determine whether intraoperative methylprednisolone improves post-operative recovery in neonates undergoing cardiac surgery.METHODS:
Neonates undergoing cardiac surgery with cardiopulmonary bypass at 2 centers were enrolled in a double-blind randomized controlled trial of methylprednisolone (30 mg/kg) or placebo after the induction of anesthesia. The primary outcome was a previously validated morbidity-mortality composite that included any of the following events following surgery before discharge death, mechanical circulatory support, cardiac arrest, hepatic injury, renal injury, or rising lactate level (>5 mmol/l).RESULTS:
Of the 190 subjects enrolled, 176 (n = 81 methylprednisolone, n = 95 placebo) were included in this analysis. A total of 27 (33%) subjects in the methylprednisolone group and 40 (42%) in the placebo group reached the primary study endpoint (odds ratio [OR] 0.63; 95% confidence interval [CI] 0.31 to 1.3; p = 0.21). Methylprednisolone was associated with reductions in vasoactive inotropic requirements and in the incidence of the composite endpoint in subjects undergoing palliative operations (OR 0.38; 95% CI 0.15 to 0.99; p = 0.048). There was a significant interaction between treatment effect and center. In this analysis, methylprednisolone was protective at 1 center, with an OR 0.35 (95% CI 0.15 to 0.84; p = 0.02), and not so at the other center, with OR 5.13 (95% CI 0.85 to 30.90; p = 0.07).CONCLUSIONS:
Intraoperative methylprednisolone failed to show an overall significant benefit on the incidence of the composite primary study endpoint. There was, however, a benefit in patients undergoing palliative procedures and a significant interaction between treatment effect and center, suggesting that there may be center or patient characteristics that make prophylactic methylprednisolone beneficial.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Metilprednisolona
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Ponte Cardiopulmonar
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Cardiopatias Congênitas
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Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Clinical_trials
/
Incidence_studies
/
Prognostic_studies
Limite:
Female
/
Humans
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Male
/
Newborn
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2019
Tipo de documento:
Article