Use of vasoactive agents in postoperative pediatric cardiac patients: Insights from a national database

Loomba, Rohit S.; Flores, Saúl

doi:10.1111/chd.12837

Cited by 18 publications

(14 citation statements)

References 9 publications

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“…Although the use of vasoactive agents has decreased in recent years in children undergoing congenital heart surgery [7], the association between sodium bicarbonate and increased use of all vasoactive medications may not be unexpected, as it may represent patients who developed poor oxygen delivery with lactic acidosis related to hemodynamic instability. It may also reflect the practice that during patient resuscitation situations, clinicians will attempt alternative therapies in an effort to stabilize hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

et al. 2019

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The objectives of this study were to characterize the use of sodium bicarbonate in pediatric cardiac admissions that experience cardiac arrest, to determine sodium bicarbonate use over the years, and to determine the impact of sodium bicarbonate on length of admissions, billed charges, and inpatient mortality. A cross-sectional study was conducted utilizing the Pediatric Health Information System database. Characteristics of admissions with and without sodium bicarbonate were initially compared by univariate analyses. The frequency by which sodium bicarbonate was used was compared by year. Regression analyses were conducted to determine the impact of sodium bicarbonate on length of stay, billed charges, and inpatient mortality. A total of 3987 (50.3%) of pediatric cardiac intensive care admissions with cardiac arrest utilized sodium bicarbonate; however, frequency changed from 62.1% in 2004 to 43.7% in 2015. Linear regression analysis demonstrated a decrease in length of stay (−27.5 days, p < 0.01) and billed charges (−$470,906, p < 0.01). Logistic regression analysis demonstrated an increase in mortality (odds ratio 1.77, 95% confidence interval 1.56–2.01). In conclusion, sodium bicarbonate is being used with less frequency over the last years in pediatric cardiac admissions with cardiac arrest. After adjustment for cardiac diagnoses, comorbidities, vasoactive medications, and other resuscitation medications, sodium bicarbonate is independently associated with increased mortality.

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Section: Discussionmentioning

confidence: 99%

Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

et al. 2019

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“…Furthermore, the elevation of the SVR, PVR, or provocation of tachyarrhythmias by these agents can inadvertently cause or exacerbate LCOS. In a recent survey of cardiac intensivists, epinephrine and dopamine were the most common agents in this class used to prevent or treat LCOS, and these medications are most commonly started while on or coming off CPB [14] . However, in a recent Pediatric Health Information System (PHIS) database review of over 43,000 cardiac surgeries in children, the frequency of use of catecholaminergic inotropes has decreased in the past ten years [15] .…”

Section: Catecholaminergic Inotropesmentioning

confidence: 99%

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

Sahulee¹,

McKinstry²

2022

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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.

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“…Epinephrine, norepinephrine, and dopamine are alpha (α) and beta-(β) receptor agonists that promote inotropy and peripheral vasoconstriction in a dose-dependent manner. 6,[48][49][50][51][52] These drugs • Single centre • Prospective…”

Section: Adrenergic Pathway Targeting Agentsmentioning

confidence: 99%

“…• are commonly used in the post-operative cardiac care of children, 6,7 but only 1 study to date investigated the efficacy of epinephrine 12 and no studies were found on the efficacy of norepinephrine or dopamine. In a study of 39 children, epinephrine dosages of 0.01-0.23 μg/kg/minute was not shown to prevent post-operative low cardiac output syndrome.…”

Section: Chu Et Al 2000 43mentioning

confidence: 99%

“…These findings are despite the fact that according to the Society of Thoracic Surgeons database, >22,000 children undergo cardiopulmonary bypass surgery each year, and that by previously published estimates, 90% of post-operative paediatric patients receive inotropes or vasoactives. 6,76 While reasons for the relative lack of studies are likely multifactorial, low consent rates, cost, and current study designs that interfere with the complex and high stakes clinical care delivered in the post-operative setting are likely key drivers. 8,77 Parental, as well as provider, stress, and anxiety, coupled with children being at significant medical and surgical risk while undergoing invasive procedures, is also likely to reduce consent rates.…”

Section: Current Knowledge Gapsmentioning

confidence: 99%

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An evidence-based review of the use of vasoactive and inotropic medications in post-operative paediatric patients after cardiac surgery with cardiopulmonary bypass from 2000 to 2020

et al. 2020

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Background: Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use. Methods: To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth – 18 years of age. Two reviewers independently reviewed studies to determine final eligibility. Results: The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses. Conclusion: Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.

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Use of vasoactive agents in postoperative pediatric cardiac patients: Insights from a national database

Cited by 18 publications

References 9 publications

Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

Use of Sodium Bicarbonate During Pediatric Cardiac Admissions with Cardiac Arrest: Who Gets It and What Does It Do?

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

An evidence-based review of the use of vasoactive and inotropic medications in post-operative paediatric patients after cardiac surgery with cardiopulmonary bypass from 2000 to 2020

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