Prevalence and clinical implications of heightened plastic chemical exposure in pediatric patients undergoing cardiopulmonary bypass

Authors

Devon Guerrelli, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
Manan Desai, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
Youssef Semaan, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
Yasin Essa, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
David Zurakowski, Department of Anesthesiology, Critical Care and Pain Medicine, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Francesca Cendali, Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Julie Reisz, Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Angelo D'Alessandro, Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Naomi Luban, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Nikki Gillum Posnack, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.

Document Type

Journal Article

Publication Date

4-8-2024

Journal

Transfusion

DOI

10.1111/trf.17821

Keywords

cardiopulmonary bypass; di(2‐ethylhexyl)phthalate; pediatric; phthalate plasticizers; red blood cells

Abstract

BACKGROUND: Phthalate chemicals are used to manufacture plastic medical products, including many components of cardiopulmonary bypass (CPB) circuits. We aimed to quantify iatrogenic phthalate exposure in pediatric patients undergoing cardiac surgery and examine the link between phthalate exposure and postoperative outcomes. STUDY DESIGN AND METHODS: The study included pediatric patients undergoing (n=122) unique cardiac surgeries at Children's National Hospital. For each patient, a single plasma sample was collected preoperatively and two additional samples were collected postoperatively upon return from the operating room and the morning after surgery. Concentrations of di(2-ethylhexyl) phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry. RESULTS: Patients were subdivided into three groups, according to surgical procedure: (1) cardiac surgery not requiring CPB support, (2) cardiac surgery requiring CPB with a crystalloid prime, and (3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with an RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience postoperative complications. RBC washing was an effective strategy to reduce phthalate levels in CPB prime. DISCUSSION: Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with an RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure.

APA Citation

Guerrelli, Devon; Desai, Manan; Semaan, Youssef; Essa, Yasin; Zurakowski, David; Cendali, Francesca; Reisz, Julie; D'Alessandro, Angelo; Luban, Naomi; and Posnack, Nikki Gillum, "Prevalence and clinical implications of heightened plastic chemical exposure in pediatric patients undergoing cardiopulmonary bypass" (2024). GW Authored Works. Paper 4755.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4755

Department

Pediatrics