Concurrent Use of Calcium Chloride and Arginine Vasopressin Infusions in Pediatric Patients with Acute Cardiocirculatory Failure

Karan B. Karki, Jeffrey Towbin, Camden Harrell, James Tansey, Joseph Krebs, William Bigelow, Arun Saini, Sachin D. Tadphale

Research output: Contribution to journalArticle

Abstract

Acute heart failure (AHF) can cause low cardiac output and poor end-organ perfusion. Inotropic agents along with vasodilators can improve organ perfusion. Arginine vasopressin (AVP) and calcium chloride (CaCl) infusions are increasingly being used in low cardiac output states in pediatric AHF. We retrospectively reviewed 77 patients (0–18 years) with AHF admitted between January 2014 and May 2017 who received concurrent AVP and CaCl infusions. Surrogates of cardiac output and organ perfusion included hemodynamic vital signs, laboratory parameters, and urine output (UO). Organ dysfunction and vasopressor inotropic scores were also calculated. Median (IQR) age was 0.88 years (0, 3.75), and median weight was 6.62 kg (3.5, 13.7). Congenital heart disease was present in 70% (46/77) patients. Univentricular physiology was present in 25% (25/77) patients. None of the patients were in the immediate postoperative period. Median durations of AVP and CaCl were 2 days (1, 3) and 3 days (2, 6), respectively. Using Wilcoxon-signed rank test and Bonferroni correction, post hoc comparison showed that at 8 h post infusion, all systolic blood pressure (SBP) and diastolic blood pressure (DBP) results, and UO were greater than those 1 h prior to infusion. Median SBP increased from 79 mm Hg (71, 92) 1 h prior to 97 mm Hg (84, 107) 8 h post. Median DBP increased from 44 mm Hg (35, 52) 1 h prior to 54 mm Hg (44, 62) 8 h post. Heart rate showed a decrease between measurements 1 h prior to infusion and 8 h post, with median scores 146 (127, 162) and 136 (114, 150) beats per minute, respectively. Within first 8 h, median UO continuously increased from 6 mL/h. (0, 25) at 1 h post infusion to 20 mL/h. (2, 62) at 8 h post infusion. Median pediatric logarithmic organ dysfunction scores on days 4 through 7 post infusion were lower compared to day 1; median vasopressor inotropic scores on day 2 through 7 post infusion were lower compared to day 1. Serum lactate level, arterial pH, and base excess all showed favorable trend. Concurrent use of AVP and CaCl infusions may improve surrogates of cardiac output, and intensive care outcomes, and prevent organ dysfunction in children with AHF.

Original languageEnglish (US)
Pages (from-to)1046-1056
Number of pages11
JournalPediatric Cardiology
Volume40
Issue number5
DOIs
StatePublished - Jun 15 2019

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Calcium Chloride
Arginine Vasopressin
Pediatrics
Blood Pressure
Heart Failure
Low Cardiac Output
Perfusion
Urine
Cardiac Output
Organ Dysfunction Scores
Vital Signs
Critical Care
Nonparametric Statistics
Vasodilator Agents
Postoperative Period
Heart Diseases
Lactic Acid
Heart Rate
Hemodynamics
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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Concurrent Use of Calcium Chloride and Arginine Vasopressin Infusions in Pediatric Patients with Acute Cardiocirculatory Failure. / Karki, Karan B.; Towbin, Jeffrey; Harrell, Camden; Tansey, James; Krebs, Joseph; Bigelow, William; Saini, Arun; Tadphale, Sachin D.

In: Pediatric Cardiology, Vol. 40, No. 5, 15.06.2019, p. 1046-1056.

Research output: Contribution to journalArticle

Karki, Karan B. ; Towbin, Jeffrey ; Harrell, Camden ; Tansey, James ; Krebs, Joseph ; Bigelow, William ; Saini, Arun ; Tadphale, Sachin D. / Concurrent Use of Calcium Chloride and Arginine Vasopressin Infusions in Pediatric Patients with Acute Cardiocirculatory Failure. In: Pediatric Cardiology. 2019 ; Vol. 40, No. 5. pp. 1046-1056.
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