Impact of Corticosteroids on Cardiopulmonary Bypass Induced Inflammation in Children:A Meta-Analysis

Ann Thorac Surg. 2020 Dec 9. Online ahead of print

Background

Corticosteroids (CS) suppress the inflammatory response to cardiopulmonary bypass in children undergoing cardiac surgery. What is less clear is the impact of CS on the postoperative course.

Methods

A systematic review and meta-analysis of prospective randomized blinded placebo-controlled trials of pediatric patients who received CS or saline placebo prior to surgery was performed. Ten studies met inclusion criteria for a total of 768 patients. In a pre-specified subgroup analysis, studies that either were limited to Society of Thoracic Surgeons – European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories 1 and 2 or excluded neonates were eliminated and a secondary analysis was conducted, which consisted of 7 studies and 555 patients.

Results

CS were associated with a significant improvement in fluid balance at 24 and 36 hours following surgery, with a mean difference of -15.2 ml/kg, 95% CI [-25.3 to -5.1 ml/kg], p = <0.01) and -5.7 ml/kg, 95% CI [-9.8 to -1.6 ml/kg], p = <0.01, respectively. CS had no impact on the incidence of infection or mortality. With the secondary analysis, CS were associated with a trend toward significance in shortening the duration of mechanical ventilation (mean difference -0.7 days, 95% CI [-1.7 to 0.1], p = 0.08).

Conclusions

CS were found to have a favorable impact on postoperative fluid balance and may be associated with shortening the duration of mechanical ventilation. While CS had no impact on mortality, they may be beneficial, particularly in neonates and those undergoing high complexity surgery.