Disadvantages of Prostacyclin Infusion During Cardiopulmonary Bypass: A Double-Blind Study of 50 Patients Having Coronary Revascularization

Abstract Prostacyclin (PGI 2 ) has been suggested for use in cardiopulmonary bypass (CPB) because of its positive effects on platelet number and function. Fifty patients who underwent coronary artery bypass grafting using a bubble oxygenator received heparin, 3 mg per kilogram of body weight, and then were randomly assigned to receive PGI 2 , 25 ng/kg/min, beginning 5 minutes before and until the end of CPB (26 patients) or a placebo (24 patients). Both groups were similar in sex, age, heparin dose, protamine dose, and CPB time. During CPB, mean arterial pressure fell significantly with PGI 2 (76 ± 2 mm Hg to 53 ± 2 mm Hg; p 3 versus 130 ± 8 × 10 3 ; not significant [NS]) and were unchanged 3 hours after CPB. Total chest tube output was 647 ± 51 ml (placebo group) versus 576 ± 34 ml (PGI 2 group) (NS); 18 of the patients given PGI 2 required 26 transfusions compared with 16 transfusions in 8 of the patients given a placebo ( p 2 patients, arterial oxygen tension on 100% oxygen fell from 281 ± 18 mm Hg before CPB to 223 ± 17 mm Hg immediately after CPB ( p 2 (TXB 2 ) from 150 ± 30 to 360 ± 60 pg/ml ( p 2 patients but it was not significantly increased in the placebo group (180 ± 30 to 270 ± 40 pg/ml; NS). At 25 ng/kg/min, PGI 2 has no demonstrable beneficial effect on platelet count or postoperative bleeding in patients having elective cardiac operations. Deleterious effects on mean arterial pressure, arterial oxygen tension, and TXB 2 levels during and after CPB are associated with administration of PGI 2 at this dosage.