Babies who have had heart surgery do not recover better with nitric oxide

27.06.2022 20:30

Babies who have had heart surgery do not recover better with nitric oxide

During heart surgery on babies, more and more nitrogen monoxide is added to the heart-lung machine as an anti-inflammatory. The world’s largest study by researchers from the University of Zurich and its partner university in Queensland has now shown that the children who have been operated on do not recover better when nitric oxide is used.

About one in 100 babies suffers from a congenital heart defect. In the United States alone, approximately 40,000 children are born with congenital heart defects each year. About half of these children will require heart surgery within the first few years of life. A cardiopulmonary bypass, an artificial heart-lung machine, is used. Children who have had heart surgery often suffer severe inflammation for several days in response to the heart-lung machine. This inflammation weakens the heart and leads to organ dysfunction, so the children have to be ventilated in the intensive care unit. In order to avoid these side effects, the addition of nitric oxide to the heart-lung machine is being discussed as a promising method.

Ventilation for the same length of time after the operation

Researchers from the University of Zurich, the Children’s Hospital and the partner university Queensland in Australia have now investigated whether adding nitric oxide to artificial heart-lung machines reduces the need for ventilation in young children after surgery.

“1371 children in six centers for pediatric heart surgery in Australia, New Zealand and the Netherlands took part in the randomized study,” says lead author Luregn Schlapbach from the Children’s Hospital Zurich. It was found that the small patients who received nitric oxide needed to be ventilated for the same amount of time after the operation as those without. The authors from UZH and the University of Queensland therefore conclude that the use of nitric oxide in cardiopulmonary bypass does not improve recovery after cardiac surgery in young children.

World’s largest study

It is the world’s largest interventional study in children with heart defects. “This large cohort is now being analyzed further, also at the level of gene expression, in order to better understand how treatment can be further improved in the future – also with regard to personalized medicine,” says Schlapbach. A follow-up study was also conducted with the examined children up to school age in order to understand the long-term effects of the nitrous oxide gas intervention.

Scientific contacts:

Luregn Schlapbach
Head of Intensive Care Medicine and Neonatology
Children’s Hospital Zurich
Tel. +41 44 266 37 90
E-Mail: [email protected]


Schlapbach LJ, Gibbons KS, Horton SB, et al. Effect of nitric oxide via cardiopulmonary bypass on ventilator-free days in young children undergoing congenital heart disease surgery: the NITRIC randomized clinical trial. Juni 27, 2022. JAMA. DOI: doi:10.1001/jama.2022.9376

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