Nitric oxide during heart surgery of no benefit in young kids

The delivery of nitric oxide into the cardiopulmonary bypass in young children undergoing surgery for congenital heart disease does not significantly reduce the number of ventilator-free days, as shown in a study.

A total of 1,371 children (mean age 21.2 weeks, 42.8 percent girls) undergoing congenital heart surgery, of whom 1,364 children completed the trial. They were randomized to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n=679) or standard care cardiopulmonary bypass without nitric oxide (n=685).

The primary endpoint of the number of ventilator-free days over 28 days following treatment was similar in the nitric oxide and standard care groups (median, 26.6 vs 26.4 days; absolute difference, −0.01 days, 95 percent confidence interval [CI], −0.25 to 0.22; p=0.92).

In terms of the secondary endpoint, a composite of low cardiac output syndrome within 48 hours, requirement of extracorporeal support within 48 hours, or death by day 28 was documented in 22.5 percent of patients in the nitric oxide group and 20.9 percent in the standard care group (adjusted odds ratio, 1.12, 95 percent CI, 0.85–1.47).

There were no significant between-group differences in the length of stay in the intensive care unit, length of stay in the hospital, and postoperative troponin levels.

The present data do not support the delivery of nitric oxide into the cardiopulmonary bypass oxygenator during heart surgery in infants.