scholarly journals Take it or levo it: an updated look at the use of levosimendan to prevent low cardiac output syndrome in pediatric patients

2021 ◽  
Author(s):  
Genevieve E. Staudt ◽  
Bevan P. Londergan ◽  
Susan S. Eagle
Keyword(s):  
Cardiac Output ◽  
Pediatric Patients ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals Prophylactic use of levosimendan in pediatric patients undergoing cardiac surgery: a prospective randomized controlled trial

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Anbiao Wang ◽  
Chaomei Cui ◽  
Yiou Fan ◽  
Jie Zi ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Plasma Concentrations ◽  
Trial Registration ◽  
Double Blind ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Post Surgery

Abstract Background The administration of levosimendan prophylactically to patients undergoing cardiac surgery remains a controversial practice, and few studies have specifically assessed the value of this approach in pediatric patients. This study therefore sought to explore the safety and efficacy of prophylactic levosimendan administration to pediatric patients as a means of preventing low cardiac output syndrome (LCOS) based upon hemodynamic, biomarker, and pharmacokinetic readouts. Methods This was a single-center, double-blind, randomized, placebo-controlled trial. Patients ≤ 48 months old were enrolled between July 2018 and April 2019 and were randomly assigned to groups that received either placebo or levosimendan infusions for 48 h post-surgery, along with all other standard methods of care. LCOS incidence was the primary outcome of this study. Results A total of 187 patients were enrolled, of whom 94 and 93 received levosimendan and placebo, respectively. LCOS incidence did not differ significantly between the levosimendan and placebo groups (10 [10.6%] versus 18 [19.4%] patients, respectively; 95% confidence interval [CI] 0.19–1.13; p = 0.090) nor did 90-day mortality (3 [3.2%] versus 4 [4.3%] patients, CI 0.14–3.69, p = 0.693), duration of mechanical ventilation (median, 47.5 h and 39.5 h, respectively; p = 0.532), ICU stay (median, 114.5 h and 118 h, respectively; p = 0.442), and hospital stay (median, 20 days and 20 days, respectively; p = 0.806). The incidence of hypotension and cardiac arrhythmia did not differ significantly between the groups. Levels of levosimendan fell rapidly without any plateau in plasma concentrations during infusion. A multiple logistic regression indicated that randomization to the levosimendan group was a predictor of LCOS. Conclusions Prophylactic levosimendan administration was safe in pediatric patients and had some benefit to postoperative hemodynamic parameters, but failed to provide significant benefit with respect to LCOS or 90-day mortality relative to placebo. Trial registration Name of the registry: Safety evaluation and therapeutic effect of levosimendan on the low cardiac output syndrome in patients after cardiopulmonary bypass. Trial registration number: ChiCTR1800016594. Date of registration: 11 June 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx

Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

2018 ◽  
Vol 19 (5) ◽  
pp. 676-687
Author(s):  
G.G. Khubulava ◽  
A.B. Naumov ◽  
S.P. Marchenko ◽  
O.Yu. Chupaeva ◽  
A.A. Seliverstova ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

scholarly journals Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rafael Alves Franco ◽  
Juliano Pinheiro de Almeida ◽  
Giovanni Landoni ◽  
Thomas W. L. Scheeren ◽  
Filomena Regina Barbosa Gomes Galas ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Prolonged Mechanical Ventilation ◽  
Kidney Injury ◽  
Composite Endpoint ◽  
Tissue Perfusion ◽  
Hospital Length Of Stay ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Noninferiority Trial

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

HEMODYNAMIC EFFECTS OF HYDROCORTISONE IN NEONATES WITH LOW CARDIAC OUTPUT SYNDROME AFTER CARDIAC SURGERY

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A49
Author(s):  
Heather Dickerson ◽  
Antonio R Mott ◽  
Jack F Price ◽  
Anthony C Chang ◽  
Pertti K Suominen ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Hemodynamic Effects ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output
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