Central Venous to Arterial CO2 Difference and Low Cardiac Output Syndrome Related Outcomes in Children After Cardiac Surgery

Prince of Songkla University136 enrolled

Overview

The goal of this clinical trial is to compare the capability of 3 different bedside surrogates in children who underwent cardiac surgery and were admitted in intensive care unit. These test are lactate, oxygen saturation from central venous and the carbon dioxide gap between central venous and arterial. The main questions is which one is the best prognostication for post operation poor outcomes Participants will be taken routine blood test for post cardiac care (at ICU arrival, 6, 12, and 24 hour post operation) and follow the their outcomes. There is no any intervention or drug in this research

Study Type

OBSERVATIONAL

Enrollment

136

Conditions

Congenital Heart Disease Perioperative/Postoperative Complications Lactate Blood Increase

Interventions

arterial and central venous blood gas analysis, lactate

Eligibility

Sex: ALLMin age: 1 DayMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Children aged 0-18 years old with either congenital or acquired cardiac disease * Undergone cardiopulmonary bypass for cardiac surgery * Be admitted in PICU for post-operative care Exclusion Criteria: * Preterm infant (GA \< 37 weeks) or weight less than 2 kg * Patient who weaned off cardiopulmoanry bypass and required extracorporeal membrane oxygenator (ECMO) before leaving the operating room * Patient who required emergency cardiac operation within 24 hour after hospitalization * Patient who had significant residual left side outflow tract obstruction (e.g., coarctation of aorta, interrupted aortic arch) which defined by difference of SBP between upper and lower extremities more than 10 mmHg * Patient who had already participated in another research project * Patient who does not have both arterial line and central line catheter back from operating room * Parents or legal guardian refuse to inform consent.

Outcomes

Primary Outcomes

number of participant who developed low cardiac output syndrome related poor outcomes within 24 hour post operation

the low cardiac output syndrome (LCOS) related poor outcomes was diagnosed if at least two of the following criteria were met within 24 hours postoperatively: 1. clinical LCOS: prolonged capillary refill \>3 seconds, systolic blood pressure \<5th percentile for age and sex, persistent elevation of left atrial pressure \>10 mmHg for at least 6 hours, and low urinary output (\<1 mL/kg/hour) for at least 6 hours despite diuretic use 2. laboratory LCOS: persistently elevated lactate level (\>2 mmol/L), metabolic acidosis with an increase in the base deficit (\>4 mmol/L) for at least 6 hours consecutively 3. Vasoactive-inotropic score ≥20 4. any unplanned surgery or intervention, cardiac arrest, or utilization of ECMO 5. left ventricular fraction \<50% on echocardiography

Time frame: from time of subject was admitted to ICU until the 24 hour post operation

Secondary Outcomes

ventilator days

number of the days subject was intubated and used mechanical ventilator after operation

Time frame: from date of subject was admitted to ICU until the date of subject was extubated, assessed up to 28 days

inotrope days

number of the days subject was on inotropic medication after operation

Time frame: from date of subject was admitted to ICU until the date of subject was free of inotropic drugs, assessed up to 28 days

length of stay in ICU

number of the days subject was stay in ICU after operation

Time frame: from date of subject was admitted to ICU until the date of subject was discharge, assessed up to 28 days