The Value Of Methylprednisolone Used In Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass:A Systematic Review And Meta-analysis

Objective:To evaluate the effects of perioperative administration of methylprednisolone in pediatric patients undergoing cardiac surgery together with cardiopulmonary bypass.Methods:Randomized controlled trials published in English language involving pediatric patients aged under 16 years undergoing cardiac surgery together with cardiopulmonary bypass,which prophylactic perioperative methylprednisolone administrated during cardiac surgery was compared with placebo or blank control were included.The Pubmed,Embase,Medline,and the Cochrane Library were searched systematically up to May2016.The search strategy was methylprednisolone AND "cardiopulmonary bypass" OR "CPB".The primary outcome to evaluate the efficacy of methylprednisolone in pediatric cardiac surgery with cardiopulmonary bypass was all-cause in-hospital mortality.The meta-analysis was performed by Revman 5.3 software.A subgroup analysis about delivery method was made between intravenous administration beforesurgery(subgroup A)and CPB circuit prime(subgroup B).Results:Six RCTS with 486 patients were included into this meta-analysis,including 253 patients with methylprednisolone and 233 patients with placebo or blank control.Fore RCTS reported the information of random sequence generation,2 RCTS reported adequate information about allocation concealment.All of the included RCTs described off or lost,5 RCTs reportde blinding of outcome assessment and 5 RCTS didnt report selective results,other bias were uncertain.Compared with placebo patients,methylprednisolone administration was associated with significant reduction of postoperative mortality(RR=0.22,95 CI: 0.06 to 0.83,P=0.03).The results of meta-anaysis showed that the CPB time was decreased in experimental groups(MD=-10.67,95% CI:-17.82 to-3.53,P=0.003),and similar trend was found in subgroup A,the MD(95% CI)was-0.72(95%CI:-1.33 to-0.12,P=0.02).There was no relation with decreased cross-clamp time,mechanical ventilation time and lengh of ICU stay in subgroup B.Conclusion:Under the limited evidence,the delivery method of intravenous administration before surgery may be better than CPB cireuit in CPB prime to deerease ICU stay and CPB time.