Abstract 17441: The Clinical Factors Agreed Upon by Pediatric Cardiac Intensivists to Define Low Cardiac Output Syndrome
Background: Low cardiac output syndrome (LCOS) is a frequent complication following congenital heart surgery (CHS), but there is no consensus on how best to define the condition. We aimed to empirically derive a definition for LCOS using senior cardiac intensivists’ clinical diagnoses as the gold standard.
Methods: This was a prospective observational study. Three senior cardiac intensivists at a single center independently evaluated a cohort of 100 patients following CHS and determined whether the patients had LCOS or not at the time of exam. They reported the level of confidence in their diagnosis using a Likert scale from 1-10, with 1 being not at all confident and 10 being very confident. Patients were categorized as such: 1). All 3 intensivists agreed on the diagnosis with high confidence (Likert score ≥ 5). 2). Lack of confidence in the diagnosis (no score ≥ 5). 3). No agreement on the diagnosis (mixed score). The investigators collected clinical data including physiologic and laboratory variables at the time of assessment. We then performed logistic regression using candidate predictors including heart rate, mean arterial pressure, central venous pressure (CVP), urine output, vasoactive inotrope score (VIS), total fluid received, serum creatinine, and peak lactate to determine which variables associated with odds of LCOS diagnosis in Group 1 patients.
Results: One hundred patients age 1 day to 17.3 years (mean: 35.9 months) were evaluated within 24 hours of being admitted to the Pediatric Cardiothoracic Unit for postoperative management (mean time of evaluation: 13.5 hours ± 8.8). The intensivists agreed 61% of the time with high confidence (6 were diagnosed with LCOS and 55 were diagnosed as not in LCOS). Following logistic regression, CVP (p< 0.01), VIS (p<0.0005), and peak lactate (p <0.05) were significant independent predictors of receiving the diagnosis of LCOS.
Conclusion: Expert intensivists do not agree on the clinical diagnosis of LCOS in 40% of cases, underscoring the need to better define this condition. In cases where there was strong agreement on a positive diagnosis of LCOS, elevated CVP, a higher VIS, and elevated peak lactate were significant clinical predictors.
- © 2013 by American Heart Association, Inc.