scholarly journals Pharmacologic therapies for the low cardiac output syndrome in children after cardiac surgery: evidence of their efficacy and trends in their use

Vessel Plus ◽  
2022 ◽  
Author(s):  
Raj Sahulee ◽  
Jaclyn McKinstry
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Successful Management ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Pulmonary Vasodilators ◽  
Current Trends ◽  
Pharmacologic Agents ◽  
Pharmacologic Therapies ◽  
Provider Surveys

The low cardiac output syndrome describes the phenomenon of the reduction of cardiac output that can occur following cardiac surgery requiring cardiopulmonary bypass. If unrecognized or untreated, this condition can result in significant morbidity and mortality. Along with non-pharmacologic therapies, pharmacologic agents used to help manage the low cardiac output syndrome include catecholamine inotropes, inodilators, systemic vasodilators, pulmonary vasodilators, and other classes of medications. We summarize the rationale and key evidence supporting the use of these therapies in children. In addition, utilizing provider surveys and registry reviews, we describe the current trends in the use of these medications and the variation demonstrated between providers and centers. Given the heterogeneous etiology of low cardiac output syndrome, successful management requires that pharmacologic therapies be tailored to the physiologic derangements of each patient.

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

Cardiovascular System

2015 ◽  
pp. 423-450
Author(s):  
Wolf Benjamin Kratzert ◽  
Eva Katherine Boyd
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Pericardial Tamponade ◽  
Right Ventricular Failure ◽  
Orthotopic Heart Transplantation ◽  
Low Cardiac Output Syndrome ◽  
Future Directions ◽  
Low Cardiac Output ◽  
Hemodynamic State

This chapter addresses underlying physiology, diagnostics, and management of common cardiovascular abnormalities in the patient after cardiac surgery. The goal is to provide insights into daily management, areas of controversy, and future directions in the field. After reviewing basic physiologic principles of cardiac output and circulation; problems affecting the postoperative hemodynamic state will be addressed individually. Specific topics include the low cardiac output syndrome, right ventricular failure, myocardial ischemia, diastolic dysfunction, vasodilatory syndrome, rhythm disturbances, pericardial tamponade, and cardiac arrest. Patients with postoperative open chests, or after orthotopic heart transplantation are also discussed.

P2792Preoperative levosimendan improves survival in patients with low cardiac output syndrome undergoing cardiac surgery: a meta-analysis of randomized controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Brockmeyer ◽  
Y Lin ◽  
A Karathanos ◽  
C Parco ◽  
T Krieger ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Low Cardiac Output Syndrome ◽  
Ventricular Assist ◽  
Low Cardiac Output

Abstract Background and purpose Previous studies and meta-analyses of perioperative levosimendan to improve the outcomes of patients with low cardiac output syndrome (LCOS) undergoing cardiac surgery have given controversial results and the optimal time of infusion of levosimendan remains uncertain. We thus aimed to elucidate the risk/benefit ratio of preoperative levosimendan in a meta-analysis of randomized controlled trials (RCTs). Methods Online databases were searched for RCTs comparing preoperative levosimendan to placebo in patients with LCOS undergoing cardiac surgery until February 2019. Data from retrieved studies were abstracted and analyzed in a comprehensive meta-analysis. Primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, renal failure/replacement therapy, need for inotropic therapy, need for left ventricular assist devices, ventricular arrhythmia and arterial hypotension. Results As a result of the online database search, six eligible RCTs with 1,326 patients were included in the meta-analysis. Preoperative levosimendan showed a significant reduction in all-cause mortality (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.29–0.83; p<0.01), renal failure/replacement therapy (OR 0.48, CI 0.29–0.80; p<0.01) and need for inotropic therapy (OR 0.24, CI 0.06–0.95; p=0.04) compared to placebo. There were no significant differences in levosimendan vs. placebo concerning the rates of myocardial infarction (OR 0.61, p=0.38), need for left ventricular assist devices (OR 0.38, p=0.1), ventricular arrhythmia (OR 0.7, p=0.33), and arterial hypotension (OR 1.28, p=0.07). Conclusions Preoperative administration of levosimendan may improve survival in patients with low cardiac output syndrome undergoing cardiac surgery. It reduces need for inotropic medical support and renal failure/replace-ment therapy compared to placebo.

Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

2020 ◽  
Vol 58 ◽  
pp. 89-95
Author(s):  
Alberto Zangrillo ◽  
Vladimir V. Lomivorotov ◽  
Antonio Pisano ◽  
Maria Grazia Calabrò ◽  
Alessandro Belletti ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Randomized Trial ◽  
Low Cardiac Output Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Low Cardiac Output ◽  
Multicenter Randomized Trial

scholarly journals The Use of Large Doses of Adrenaline and Other Vasopressors in the Low Cardiac Output Syndrome after Cardiac Surgery—A Report of Four Cases

1974 ◽  
Vol 2 (1) ◽  
pp. 58-68 ◽  
Author(s):  
V. I. Callanan ◽  
G. A. Harrison
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Myocardial Metabolism ◽  
Favourable Effect ◽  
Ventricular Failure ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Blood Volume Expansion ◽  
Adrenaline Infusion ◽  
High Doses

Four cases are described of the use of prolonged and/or high doses of adrenaline in the treatment of the low cardiac output syndrome following cardiac surgery. Adrenaline was chosen because it produced a more favourable effect on central cardiovascular haemodynamics and myocardial metabolism when compared with isoprenaline, while its detrimental effects on renal function were less marked than those found when using noradrenaline. The renal insufficiency encountered was reversed in those cases without previous renal disease. Tachyphylaxis was demonstrated and weaning was achieved by gradual withdrawal of the vasopressor with concomitant blood volume expansion. Two cases with predominant right ventricular failure developed gross ascites and peripheral oedema, making control of fluid balance difficult. These problems are discussed with a summary of the relevant pharmacology of isoprenaline, noradrenaline, adrenaline and glucagon. The conclusions reached regarding the use and management of adrenaline infusion are given.

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