The Inadequate Oxygen Delivery Index and Low Cardiac Output Syndrome Score As Predictors of Adverse Events Associated With Low Cardiac Output Syndrome Early After Cardiac Bypass*

Rogers, Libby; Ray, Samiran; Johnson, Mae; Feinstein, Yael; Dominguez, Troy E.; Peters, Mark; Hoskote, Aparna; Brown, Kate

doi:10.1097/pcc.0000000000001960

Cited by 25 publications

(20 citation statements)

References 19 publications

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“…In contrast to platforms like Bedmaster™ and Etiometry® (the latter of which provides, e.g., a validated early-warning tool for shock 16 ), none of the aforementioned prognostic scores for mortality in critically ill children provides real-time analytics using continuously acquired physiologic monitoring data (e.g., minute-to-minute or higher frequency vital sign measures and/or waveforms). Neither Bedmaster™ nor Etiometry® offers a validated early-warning tool for impending cardiac arrest.…”

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confidence: 99%

Early identification of impending cardiac arrest in neonates and infants in the cardiovascular ICU: a statistical modelling approach using physiologic monitoring data

et al. 2019

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Objective:To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU.Methods:We performed a single-institution retrospective cohort study (11 January 2013–16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children’s hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model’s discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest.Results:The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%.Conclusions:Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.

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confidence: 99%

Early identification of impending cardiac arrest in neonates and infants in the cardiovascular ICU: a statistical modelling approach using physiologic monitoring data

et al. 2019

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“…At present, domestic and foreign studies on the risk factors of LCOS after CHD in children are inconsistent. It is believed that the occurrence of LCOS is caused by multiple factors, including impaired systolic and diastolic function of the heart, changes in cardiac load, and activation of inflammatory transmitters [ 14 , 15 ]. The results of our study have found that age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt were the independent risk factors of LCOS in patients with CHD.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Song

Dang

Dong

2021

J Cardiothorac Surg

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Background It’s necessary to analyze the related risk factors and complications of low cardiac output syndrome (LCOS) after operation in children with congenital heart disease (CHD), to elucidate the management strategy of LCOS. Methods CHD children admitted to the department of cardiology in our hospital from January 15, 2019 to October 31, 2020 were included. The personal and clinical data of CHD children with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. Besides, the complication and mortality of LCOS and no LCOS patients were compared. Results A total of 283 CHD patients were included, the incidence of postoperative LCOS in CHD patients was 12.37%. There were significant differences in the age, preoperative oxygen saturation, two-way ventricular shunt, duration of CPB and postoperative residual shunt between two groups (all p < 0.05). Logistic regression analyses indicated that age ≤ 4y(OR2.426, 95%CI1.044 ~ 4.149), preoperative oxygen saturation ≤ 93%(OR2.175, 95%CI1.182 ~ 5.033), two-way ventricular shunt (OR3.994, 95%CI1.247 ~ 6.797), duration of CPB ≥ 60 min(OR2.172, 95%CI1.002 ~ 4.309), postoperative residual shunt (OR1.487, 95%CI1.093 ~ 2.383) were the independent risk factors of LCOS in patients with CHD (all p < 0.05). There were significant differences in the acute liver injury, acute kidney injury, pulmonary infection, tracheotomy, duration of mechanical ventilation, length of ICU stay and mortality (all p < 0.05), no significant difference in the 24 h drainage was found(p = 0.095). Conclusion LCOS after CHD is common, more attentions should be paid to those patients with age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt to improve the prognosis of CHD patients.

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“…A LCOS score (tachycardia, oliguria, toe temperature < 30 °C, volume administration > 30 mL/kg/day, decreased near infrared spectroscopy measurements, hyperlactatemia, and need for vasoactive/inotropes in excess of milrinone at 0.5 µg/kg/min) showed an AUC for a composite morbidity (prolonged mechanical ventilation, new infection, cardiopulmonary arrest, neurologic event, renal dysfunction, necrotizing enterocolitis, and extracorporeal life support) of 0.83 in 55 patients undergoing pediatric open heart surgery [ 11 ] . Later, a modified LCOS score was superior to the inadequate oxygen delivery index in predicting adverse events linked to LCOS in 536 bypass pediatric operations for congenital heart defects [ 12 ] .…”

Section: Discussionmentioning

confidence: 99%

Central Venous Oxygen Saturation/Lactate Ratio and Prediction of Major Adverse Events after Pediatric Heart Surgery

Rocha¹,

Manso²,

Carmona³

2021

Braz J Cardiovasc Surg

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Introduction Major adverse events (MAE) are unexpected but undesirably frequent after pediatric congenital heart surgery and contribute to poorer outcomes. The aim of this study was to test the predictive value of a ratio between central venous oxygen saturation and arterial lactate (ScvO2/lactate) for MAE after pediatric congenital heart surgery in a Brazilian university hospital. Methods We conducted a retrospective observational study in a tertiary care university hospital, including 194 infants and children submitted to surgery for congenital heart disease. The predictive value of ScvO2, lactate, and ScvO2/lactate ratio were assessed by the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The incidence of MAE was 16% — cardiac arrest/death, unplanned reoperation, and low cardiac output syndrome were the most common events. Overall, ScvO2/lactate ratio discriminated patients with and without MAE very well (AUC 0.842), performing better than either variable alone, with sensitivity of 48%, specificity of 94%, PPV of 60%, and NPV of 91%. Conclusion A ScvO2/lactate ratio > 5 can accurately identify patients at low risk of MAE after pediatric congenital heart surgery, with very good specificity and NPV, but poor sensitivity and PPV.

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The Inadequate Oxygen Delivery Index and Low Cardiac Output Syndrome Score As Predictors of Adverse Events Associated With Low Cardiac Output Syndrome Early After Cardiac Bypass*

Cited by 25 publications

References 19 publications

Early identification of impending cardiac arrest in neonates and infants in the cardiovascular ICU: a statistical modelling approach using physiologic monitoring data

Early identification of impending cardiac arrest in neonates and infants in the cardiovascular ICU: a statistical modelling approach using physiologic monitoring data

Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: what can we do

Central Venous Oxygen Saturation/Lactate Ratio and Prediction of Major Adverse Events after Pediatric Heart Surgery

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