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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

Part of: Surgery

Published online by Cambridge University Press:  20 November 2020

Caitlin E. King ,
Elizabeth J. Thompson ,
Henry P. Foote ,
Kanecia O. Zimmerman ,
Kevin D. Hill ,
Reid Chamberlain Open the ORCID record for Reid Chamberlain [Opens in a new window]  and
Christoph P. Hornik Open the ORCID record for Christoph P. Hornik [Opens in a new window]
Caitlin E. King
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Elizabeth J. Thompson
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Henry P. Foote
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Kanecia O. Zimmerman
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA
Kevin D. Hill
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Reid Chamberlain
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
Christoph P. Hornik*
Affiliation:
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA
*
Author for correspondence: Christoph P. Hornik, MD, PhD, MPH, Department of Pediatrics, Duke University School of Medicine and Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA. Tel: +1 919 684 8111; Fax: +1 919 681 9457. Email: christoph.hornik@duke.edu
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Abstract

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.

Keywords

Vasoactive medicationsinotropic medicationspost-operative care for paediatric patientspost-cardiopulmonary bypass surgery
Type
Review Article
Information
Cardiology in the Young , Volume 30 , Issue 12 , December 2020 , pp. 1757 - 1771
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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