Influence of amiodarone treatment on inflammation during cardiopulmonary bypass

Introduction

Cardiopulmonary bypass (CPB) induces a systemic inflammatory response (SIRS), which causes significant morbidity or even mortality. Amiodarone (Amio) has shown to reduce postoperative atrial fibrillation and also to reduce tumor necrosis factor alpha (TNF-α) production in vitro. Whether Amio reduces the post CPB SIRS is unknown.

Hypothesis

The present study sought to investigate the anti-inflammatory properties of Amio after CABG using CPB.

Methods

Twenty-two patients undergoing elective CABG were randomly assigned to receive 600 mg Amio orally 7 days pre surgery daily and 45 mg/hour intravenously for 48 hours after initiation of CPB (10 patients, group 2) or placebo (12 patients, group 1). Two patients in group 2 were excluded due to withdrawn consent during the loading phase. The primary endpoint was the C-reactive protein (CRP) curve (AUC) up to 96 hours, and secondary endpoints were fibrinogen and WBC up to 96 hours and TNF-α and IL-6 curves up to 48 hours post surgery, respectively.

Results

Baseline characteristics were not different between groups (age 61 ± 8 vs 62 ± 10 years, male 7/8 vs 10/12, EF 576 vs 53 ± 7%, SAPS II score 19 ± 3 vs 21 ± 8, CPB duration 78 ± 15 vs 79 ± 17 min, group 2 vs group 1, P = not significant). Amio did not reduce the postoperative CRP AUC when compared with placebo (1579 ± 260 vs 1397 ± 617, P = 0.44; Fig. 1). Furthermore, no significant differences in the AUCs of fibrinogen, WBC, TNF-α and IL-6 were observed. Length of ICU and hospital stay were not different between groups (2.4 ± 1.5 vs 2.7 ± 2.0 days, P = not significant and 9.0 ± 1.4 and 13.3 ± 7.1 days, P = not significant, group 2 vs group 1, respectively). There were no deaths in either group.

Figure 1

(abstract P82)

Conclusions

In this pilot study, there was no difference in the post CPB inflammatory reaction between Amio-treated and placebo-treated patients.