Clinical and Laboratory Predictors for the Development of Low Cardiac Output Syndrome in Infants Undergoing Cardiopulmonary Bypass: A Pilot Study

Cardiac surgery employing cardiopulmonary bypass exposes infants to a high risk of morbidity and mortality. The objective of this study was to assess the utility of clinical and laboratory variables to predict the development of low cardiac output syndrome, a frequent complication following cardiac surgery in infants. We performed a prospective observational study in the pediatric cardiovascular ICU in an academic children’s hospital. Thirty-one patients with congenital heart disease were included. Serum levels of nucleosomes and a panel of 20 cytokines were measured at six time points in the perioperative period. Cardiopulmonary bypass patients were characterized by increased levels of interleukin-10, -6, and -1α upon admission to the ICU compared to non-bypass cardiac patients. Patients developing low cardiac output syndrome endured longer aortic cross-clamp time and required greater inotropic support at 12 h postoperatively compared to bypass patients not developing the condition. Higher preoperative interleukin-10 levels and 24 h postoperative interleukin-8 levels were associated with low cardiac output syndrome. Receiver operating characteristic curve analysis demonstrated a moderate capability of aortic cross-clamp duration to predict low cardiac output syndrome but not IL-8. In conclusion, low cardiac output syndrome was best predicted in our patient population by the surgical metric of aortic cross-clamp duration.

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The effect of oral triiodothyronine supplementation on lactate and pyruvate after paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951120003698 ◽

2020 ◽

pp. 1-7

Author(s):

Eva M. Marwali ◽

Putri Caesa ◽

Muhammad Rayhan ◽

Poppy S. Roebiono ◽

Dicky Fakhri ◽

...

Keyword(s):

Cardiac Output ◽

Placebo Group ◽

Cardiopulmonary Bypass ◽

Pyruvate Metabolism ◽

Aortic Cross Clamp ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Glucose Levels ◽

Lactate And Pyruvate ◽

Induction Of Anaesthesia

Abstract Objective: To determine if triiodothyronine alters lactate, glucose, and pyruvate metabolism, and if serum pyruvate concentration could serve as a predictor of low cardiac output syndrome in children after cardiopulmonary bypass procedures. Methods: This study was ancillary to the Oral Triiodothyronine for Infants and Children undergoing Cardiopulmonary bypass (OTICC) trial. Serum pyruvate was measured in the first 48 patients and lactate and glucose were measured in all 208 patients enrolled in the OTICC study on the induction of anaesthesia, 1 and 24 hours post-aortic cross-clamp removal. Patients were also defined as having low cardiac output syndrome according to the OTICC trial protocol. Result: Amongst the designated patient population for pyruvate analysis, 22 received placebo, and 26 received triiodothyronine (T3). Lactate concentrations were nearly 20 times greater than pyruvate. Lactate and pyruvate levels were not significantly different between T3 and placebo group. Glucose levels were significantly higher in the placebo group mainly at 24-hour post-cross-clamp removal. Additionally, lactate and glucose levels peaked at 1-hour post-cross-clamp removal in low cardiac output syndrome and non-low cardiac output syndrome patients, but subsequently decreased at a slower rate in low cardiac output syndrome. Lactate and pyruvate concentrations correlated with glucose only prior to surgery. Conclusion: Thyroid supplementation does not alter systemic lactate/pyruvate metabolism after cardiopulmonary bypass and reperfusion. Pyruvate levels are not useful for predicting low cardiac output syndrome. Increased blood glucose may be regarded as a response to hypermetabolic stress, seen mostly in patients with low cardiac output syndrome.

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Etiological factors and clinical value of metabolic acidosis after cardiac surgery with cardiopulmonary bypass

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2019-18-3-35-43 ◽

2019 ◽

Vol 18 (3) ◽

pp. 35-43

Author(s):

A. O. Marichev ◽

S. V. Datsenko ◽

O. V. Deinega ◽

E. A. Kabakova ◽

E. S. Kurskova ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Metabolic Acidosis ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Postoperative Period ◽

Acid Base ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Lactate Acidosis

Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate signiﬁcance of MetAc in an early postoperative period.Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inﬂammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inﬂammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inﬂammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality.

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

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2018-19-5-676-687 ◽

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

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

Annals of Intensive Care ◽

10.1186/s13613-021-00808-6 ◽

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

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

Critical Care Medicine ◽

10.1097/00003246-200412001-00182 ◽

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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Regional Blood Flow and Oxygen Transport in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

Survey of Anesthesiology ◽

10.1097/00132586-199408000-00026 ◽

1994 ◽

Vol 38 (4) ◽

pp. 215

Author(s):

ESKO RUOKONEN ◽

JUKKA TAKALA ◽

AARNO KARI

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Cardiac Surgery ◽

Oxygen Transport ◽

Regional Blood Flow ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2018.51.2.109 ◽

2018 ◽

Vol 51 (2) ◽

pp. 109-113 ◽

Cited By ~ 2

Author(s):

You Jung Ok ◽

Ju Yong Lim ◽

Sung-Ho Jung

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Critical Illness ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Corticosteroid Insufficiency

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Cardiovascular System

Advances in Medical Technologies and Clinical Practice - Modern Concepts and Practices in Cardiothoracic Critical Care ◽

10.4018/978-1-4666-8603-8.ch016 ◽

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.

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

European Heart Journal ◽

10.1093/eurheartj/ehz748.1107 ◽

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.

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