The Role of Nitric oxide in the sweep gas for patients receiving Extracorporeal Membrane Oxygenation or Cardiopulmonary Bypass

Roberto Chiletti; Sophie H Fincher; Stephen B Horton; Giles J Peek; Paul Checchia; Warwick Butt

doi:10.1016/j.cjca.2024.12.027

The Role of Nitric oxide in the sweep gas for patients receiving Extracorporeal Membrane Oxygenation or Cardiopulmonary Bypass

Can J Cardiol. 2024 Dec 27:S0828-282X(24)01324-2. doi: 10.1016/j.cjca.2024.12.027. Online ahead of print.

Authors

Roberto Chiletti¹, Sophie H Fincher², Stephen B Horton³, Giles J Peek⁴, Paul Checchia⁵, Warwick Butt⁶

Affiliations

¹ Department of Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Australia. Electronic address: [email protected].
² Department of Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Australia; Department of Critical Care, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia. Electronic address: [email protected].
³ Director of Perfusion - Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Associate Professor - Department of Paediatrics, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia; Honorary Research Fellow - Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: [email protected].
⁴ Congenital Heart Centre, University of Florida, Gainesville, USA. Electronic address: [email protected].
⁵ Professor of Pediatrics and Associate Chief for Cardiac Services and Business Operations; Division of Critical Care Medicine, Texas Children's Hospital and the Baylor College of Medicine, Houston, USA. Electronic address: [email protected].
⁶ Senior Paediatric Intensivist - Department of Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Australia; Professor - Department of Critical Care, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia; Group Leader - ICU Research Clinical Sciences Theme MCRI, Melbourne, Australia. Electronic address: [email protected].

PMID: 39733940
DOI: 10.1016/j.cjca.2024.12.027

Abstract

Nitric oxide (NO) was proclaimed the 1992 "molecule of the year" by Culotta in Science magazine because of its importance in neuroscience, physiology and immunology. Inhaled NO has been in clinical use for over 35 years to decrease pulmonary hypertension and improve oxygenation. Over the last 20 years there has been much research to understand the role of nitric oxide on cell surface receptors, mitochondria, and intracellular processes which involve calcium and superoxide radicals. This research has shown that, irrespective of the cause, NO has a major role in the systemic inflammatory response syndrome (SIRS) and ischaemia-reperfusion injury (IRI).¹ More recent clinical research has focused on NO use in patients undergoing cardiopulmonary bypass and receiving extracorporeal life support, with some centres incorporating nitric oxide into sweep gas as part of routine practice. This article reviews NO pathways in humans, the biological effects of NO, the interplay between nitric oxide and red blood cells, and animal and human studies on the effects of exogenously administered NO.

Publication types

Review