High Ionized Calcium Concentration Is Associated With Prolonged Length of Stay in the Intensive Care Unit for Postoperative Pediatric Cardiac Patients

Kimura, Satoshi; Iwasaki, Tadaaki; Oe, Katsunori; Shimizu, Kazuyoshi; Suemori, Tomohiko; Kanazawa, Tomoyuki; Shioji, Naohiro; Kuroe, Yasutoshi; Matsuoka, Yuto; Morimatsu, Hiroshi

doi:10.1053/j.jvca.2017.11.006

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…Calcium is essential for myocardial excitation-contraction coupling, and as such for myocardial contractility, especially in neonates due to limited intracellular stores. 37,38 However, calcium also has detrimental effects on myocardial function after ischemia-reperfusion injury (such as during bypass and cardiopulmonary resuscitation), likely due to the reduced capacity of the injured myocytes to handle intracellular calcium load. 37,38 Our study adds data to the previous literature demonstrating increased mortality with calcium use during paediatric cardiopulmonary resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…37,38 However, calcium also has detrimental effects on myocardial function after ischemia-reperfusion injury (such as during bypass and cardiopulmonary resuscitation), likely due to the reduced capacity of the injured myocytes to handle intracellular calcium load. 37,38 Our study adds data to the previous literature demonstrating increased mortality with calcium use during paediatric cardiopulmonary resuscitation. 7,12 Finally, we demonstrated that both the need for continuous renal replacement therapy and abnormal pupillary response during extracorporeal membrane oxygenation predicted mortality in our cohort.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

et al. 2020

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Objectives:To characterise the mortality and neurological outcomes of paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation and to identify risk factors associated with adverse outcomes in this population.Materials and methods:Observational retrospective cohort study in paediatric cardiac patients undergoing cardiopulmonary resuscitation for greater than 30 minutes prior to cannulation in a tertiary children’s hospital, from July 2000 to July 2013.Results:Seventy-three paediatric cardiac patients requiring cardiopulmonary resuscitation for more than 30 minutes prior to cannulation were included in the study. Survival to hospital discharge was 43.8%, with 75% of survivors having either normal neurologic function or only mild disability. Multivariable logistic regression analysis demonstrated that increased use of calcium during resuscitation (odds ratio 14.5, p 0.01), cardiopulmonary resuscitation duration >50 minutes (odds ratio 4.12, p 0.03), >6 interruptions of chest compressions during cannulation (odds ratio 6.40, p 0.03), the need for continuous renal replacement therapy (odds ratio 11.1, p 0.001), and abnormal pupillary response during extracorporeal membrane oxygenation (odds ratio 33.9, p 0.006) were independent predictors for hospital mortality.Conclusion:Survival after cardiopulmonary resuscitation for more than 30 minutes prior to extracorporeal membrane oxygenation cannulation in our paediatric cardiac cohort was 43.8%. Factors associated with mortality included calcium use during resuscitation, longer cardiopulmonary resuscitation, increased chest compression pauses during cannulation, the use of continuous renal replacement therapy, and abnormal pupils during extracorporeal membrane oxygenation support. A prospective assessment of these factors in paediatric cardiac patients may be beneficial in improving outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

et al. 2020

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“…In a systematic review investigating hypocalcemia in trauma patients, low iCa at admission was found to be related to elevated mortality (10). Moreover, a retrospective study including 357 pediatric patients established that high iCa level was independently associated with longer ICU stay in pediatric PCS patients (11). The reason for the association between calcium level and patient prognosis could be that calcium takes part in various physiological and biochemical processes such as heart electrophysiology and contraction, blood coagulation, neurotransmitter release, and enzyme activity regulation (12,13).…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Present researches exploring the prognostic value of calcium concentration are undermined by sample size and study design. Our study investigated the association of both total calcium (tCa) and ionized Ca (iCa) to short- and long-term mortality and other outcomes in post-cardiovascular surgery (PCS) patients admitted to intensive care unit (ICU) from two large public data sets.Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU) were inspected to identify PCS patients. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between calcium concentration and outcomes. The propensity score estimation was performed to validate our findings.Results: A total of 6122 and 914 patients were included from the MIMIC III and eICU data sets, respectively. The groups with the most patients were the mild hypo-iCa and hypo-tCa groups. The mild hypo-iCa group showed significant association with worse short-term and long-term prognosis, less use of ventilation, longer ICU and hospital stay, and more incidence of 7-day acute kidney injury.Conclusions: The mild hypo-iCa (0.9–1.15 mmol/L) within the first day of admission to the ICU could serve as an independent prognosis factor for PCS patients.

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“…Moreover, Kimura et al conducted a retrospective study at Okayama Hospital in Japan in 2017 to determine the relationship between ionized calcium concentrations and outcomes 24 h after heart surgery in children. The results of their study indicated a statistically significant association between the levels of antihypertensive drugs and serum ionized calcium levels [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables in infants undergoing open-heart surgery

et al. 2022

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Background The incidence of complications after heart surgery is a critical factor in disability, deaths, lengthening hospital stays, and increasing treatment costs. The metabolic balance of certain hormones and electrolytes is necessary for proper cardiac function. In children, various biochemical conditions may cause calcium depletion during heart surgery. The purpose of this study was to determine the effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables and clinical outcomes in infants undergoing open-heart surgery. This study was conducted at Rajaie Cardiovascular Medical and Research Center in 2021 using a controlled randomized clinical trial. A total of 60 patients with open-heart surgery weighing up to 10 kg were included in the study. The first group received an intravenous injection of calcium gluconate 20 min after opening the aortic clamp, and the second group was monitored as a control group. Data collection tools included checklists containing demographics, surgical information, and intensive care unit measures. Results The Chi-square test or Fisher's exact test showed that the frequency distribution of gender, blood group, Rhesus factor (RH), and clinical diagnosis in the two groups of intervention and control was not statistically significant (p < 0.05). The mean and standard deviation of Ejection Fraction (EF) changes (before and after) were 13.27 ± 9.16 in the intervention group and 8.31 ± 9.80 in the control group (p = 0.065). The results of two-way repeated measures ANOVA showed that mean systolic blood pressure (p = 0.030), mean diastolic blood pressure (p = 0.021), mean heart rate (p = 0.025), mean arterial pressure (p = 0.020), mean pH (p < 0.001), and mean hemoglobin (p = 0.018) in the intervention, and control groups were statistically significant. Conclusions In the present study, unlike systolic pressure, mean diastolic blood pressure decreased, and mean arterial pressure increased significantly. As a result, the slope of changes during the study period was different in the intervention and control groups.

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High Ionized Calcium Concentration Is Associated With Prolonged Length of Stay in the Intensive Care Unit for Postoperative Pediatric Cardiac Patients

Cited by 9 publications

References 30 publications

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

Outcomes of paediatric cardiac patients after 30 minutes of cardiopulmonary resuscitation prior to extracorporeal support

The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

The effect of calcium gluconate administration during cardiopulmonary bypass on hemodynamic variables in infants undergoing open-heart surgery

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