Prevention for pediatric low cardiac output syndrome: results from the European survey EuLoCOS-Paed

Abstract

Objective: Characterize current hospital practices related to preventive drug therapy for low cardiac output syndrome (LCOS) in children with open heart surgery (OHS) in Europe.

Methods: Web-based questionnaire survey of European hospitals performing OHS in children, conducted between January and August 2009.

Results: Responses to the questionnaire were obtained from 90 of 125 hospitals (72.0%) from 31 different countries across the geographical European regions. The majority of hospitals (77.8%) administered preventive drug therapy and primarily targeted patients at risk (63.3%). Twenty-four different drug regimens were reported, involving 17 drugs from seven therapeutic drug classes. Milrinone, dopamine, epinephrine, dobutamine, and levosimendan made up 85.9% of the total drug use. Furthermore, milrinone was reported in 70.7% of all drug regimens and significantly more often in combination with other drugs than monotherapy (Δ20%, 95% CI 4.7-34.1%). Milrinone combination therapy reports included lower bolus but higher maintenance infusion doses than monotherapy reports. The timing of drug regimen administration varied across the full perioperative period, but drug regimens were mostly initiated during surgery and continued postoperatively.

Conclusion: Although current hospital practices related to preventive drug therapy for LCOS in children with OHS are characterized by a marked variability, only few drugs make up the bulk of prescribing practice with milrinone being most commonly used. Therefore, the survey provides information on which drugs to focus research and establish safe and effective drug use. A unified approach is urgently needed to ensure that children with OHS can benefit from evidence-based care.