Prevention of systemic inflammatory response syndrome after emergency on-pump coronary artery bypass grafting with high-dose ascorbic acid: a prospective randomized controlled trial

Abstract

INTRODUCTION: Emergency coronary artery bypass grafting (CABG) surgery carries a risk of postperfusion systemic inflammatory response syndrome (SIRS). The prophylactic use of high doses of ascorbic acid, which possesses an antioxidant and immunomodulatory effect, may be justified, but has not been sufficiently studied in this clinical scenario. OBJECTIVE: To determine the possibilities of preventing the systemic inflammatory response with ascorbic acid (AA) during emergency coronary artery bypass grafting under cardiopulmonary bypass (CPB). MATERIALS AND METHODS: We prospectively examined 60 patients (32 men and 28 women, aged 63 (59; 70) years who underwent CABG (3 ± 1 bypass), performed for emergency indications under CPB 95 (77; 122) min. Patients were randomly divided into two groups: patients in the main group (n = 30) were given 4 grams of AA intravenously 1 hour before the skin incision, patients in the control group (n = 30) received standard pre-operative prevention of SIRS. RESULTS: The use of AA (n = 30) was accompanied by a decrease in the incidence of SIRS (20 and 47 %; p = 0.048) and a reduction in postoperative hospitalization (9 [8; 10] and 11 [10; 16] days; p = 0.013). CONCLUSIONS: Prophylactic use of AA is safe and can reduce the frequency of individual manifestations of SIRS and the duration of postoperative hospitalization.