Jonathan W Byrnes1, Adnan T Bhutta2, Mallikarjuna Rao Rettiganti3, Alberto Gomez4, Xiomara Garcia5, Umesh Dyamenahalli6, Charles Johnson7, Robert D B Jaquiss8, Michiaki Imamura7, Parthak Prodhan9. 1. Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio. 2. Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, University of Maryland, Baltimore, Maryland. 3. Department of Biostatistics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. 4. College of Medicine, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. 5. Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. 6. Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, Comer Children's Hospital, Chicago, Illinois. 7. Department of Surgery, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. 8. Department of Surgery, Duke University, Durham, North Carolina. 9. Department of Pediatrics, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. Electronic address: prodhanparthak@uams.edu.
Abstract
BACKGROUND: Hyperfibrinogenemia, which can create a procoagulant milieu, is frequently observed in patients supported with the Berlin EXCOR (Berlin Heart GmbH, Berlin, Germany) ventricular assist device (VAD). We began initiating corticosteroids in patients with systemic inflammatory response syndrome (SIRS) episodes to mitigate hyperfibrinogenemia. We set forth to describe the impact of corticosteroids on the hyperfibrinogenemic state in our institutional experience. METHODS: Retrospective data was collected on 44 consecutive patients implanted with the Berlin EXCOR VAD from April 15, 2005 through May 6, 2013. Pertinent information was abstracted from the electronic medical record. The reduction of C-reactive protein (CRP) and fibrinogen levels among days from corticosteroid treatment were described. Infections and insulin use were reported based on whether patients received steroids and if steroids were given for SIRS. RESULTS: Over the initial 44 Berlin EXCOR VAD implantations, 14 patients were treated with 21 courses of corticosteroids for SIRS episodes as identified by clinical features and rise in CRP. Treatment with corticosteroids reduced fibrinogen levels by day 2 to a statistically significant degree (p = 0.008). No difference in hyperglycemia or infections occurred among patients receiving corticosteroids for SIRS. CONCLUSIONS: Treatment with corticosteroids can potentially mitigate the SIRS response among children supported on the Berlin EXCOR VAD. In patients who received corticosteroids to mitigate inflammation, there was no increase in infections or hyperglycemia requiring insulin administration compared with patients who did not receive steroids.
BACKGROUND: Hyperfibrinogenemia, which can create a procoagulant milieu, is frequently observed in patients supported with the Berlin EXCOR (Berlin Heart GmbH, Berlin, Germany) ventricular assist device (VAD). We began initiating corticosteroids in patients with systemic inflammatory response syndrome (SIRS) episodes to mitigate hyperfibrinogenemia. We set forth to describe the impact of corticosteroids on the hyperfibrinogenemic state in our institutional experience. METHODS: Retrospective data was collected on 44 consecutive patients implanted with the Berlin EXCOR VAD from April 15, 2005 through May 6, 2013. Pertinent information was abstracted from the electronic medical record. The reduction of C-reactive protein (CRP) and fibrinogen levels among days from corticosteroid treatment were described. Infections and insulin use were reported based on whether patients received steroids and if steroids were given for SIRS. RESULTS: Over the initial 44 Berlin EXCOR VAD implantations, 14 patients were treated with 21 courses of corticosteroids for SIRS episodes as identified by clinical features and rise in CRP. Treatment with corticosteroids reduced fibrinogen levels by day 2 to a statistically significant degree (p = 0.008). No difference in hyperglycemia or infections occurred among patients receiving corticosteroids for SIRS. CONCLUSIONS: Treatment with corticosteroids can potentially mitigate the SIRS response among children supported on the Berlin EXCOR VAD. In patients who received corticosteroids to mitigate inflammation, there was no increase in infections or hyperglycemia requiring insulin administration compared with patients who did not receive steroids.
Authors: Prakash Acharya; William A Jakobleff; Stephen J Forest; Thiru Chinnadurai; Nicolas Mellas; Snehal R Patel; Jorge R Kizer; Henny H Billett; Daniel J Goldstein; Ulrich P Jorde; Omar Saeed Journal: ASAIO J Date: 2020-03 Impact factor: 3.826
Authors: Daniel P Fudulu; Ben Gibbison; Thomas Upton; Serban C Stoica; Massimo Caputo; Stafford Lightman; Gianni D Angelini Journal: Front Pediatr Date: 2018-04-20 Impact factor: 3.418