Initial Observations of the Effects of Calcium Chloride Infusions in Pediatric Patients with Low Cardiac Output

Konstantin Averin, Chet Villa, Catherine D. Krawczeski, Jesse Pratt, Eileen King, John Jefferies, David P. Nelson, David S. Cooper, Thomas D. Ryan, Jaclyn Sawyer, Jeffrey Towbin, Angela Lorts

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Myocardial contractility and relaxation are highly dependent on calcium homeostasis. Immature myocardium, as in pediatric patients, is thought to be more dependent on extracellular calcium for optimal function. For this reason, intravenous calcium chloride infusions may improve myocardial function in the pediatric patient. The objectives of this study were to report the hemodynamic changes seen after administration of continuous calcium chloride to critically ill children. We retrospectively identified pediatric patients (newborn to 17 years old) with hemodynamic instability admitted to the cardiac ICU between May 2011 and May 2012 who received a continuous infusion of calcium chloride. The primary outcome was improvement in cardiac output, assessed by arterial-mixed venous oxygen saturation (A–V) difference. Sixty-eight patients, mean age 0.87 ± 2.67 years, received a total of 116 calcium infusions. Calcium chloride infusions resulted in significant improvements in primary and secondary measures of cardiac output at 2 and 6 h. Six hours after calcium initiation, A–V oxygen saturation difference decreased by 7.4 % (32.6 ± 2.1 to 25.2 ± 2.0 %, p < 0.001), rSO2 increased by 5.5 % (63.1 vs 68.6 %, p < 0.001), and serum lactate decreased by 0.9 mmol/l (3.3 vs 2.4 mmol/l, p < 0.001) with no change in HR (149.1 vs 145.6 bpm p = 0.07). Urine output increased 0.66 ml/kg/h in the 8-h period after calcium initiation when compared to pre-initiation (p = 0.003). Neonates had the strongest evidence of effectiveness with other age groups trending toward significance. Calcium chloride infusions improve markers of cardiac output in a heterogenous group of pediatric patients in a cardiac ICU. Neonates appear to derive the most benefit from utilization of these infusions.

Original languageEnglish (US)
Pages (from-to)610-617
Number of pages8
JournalPediatric Cardiology
Volume37
Issue number3
DOIs
StatePublished - Mar 1 2016

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Low Cardiac Output
Calcium Chloride
Pediatrics
Calcium
Cardiac Output
Newborn Infant
Hemodynamics
Oxygen
Critical Illness
Lactic Acid
Myocardium
Homeostasis
Age Groups
Urine
Serum

All Science Journal Classification (ASJC) codes

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

Cite this

Initial Observations of the Effects of Calcium Chloride Infusions in Pediatric Patients with Low Cardiac Output. / Averin, Konstantin; Villa, Chet; Krawczeski, Catherine D.; Pratt, Jesse; King, Eileen; Jefferies, John; Nelson, David P.; Cooper, David S.; Ryan, Thomas D.; Sawyer, Jaclyn; Towbin, Jeffrey; Lorts, Angela.

In: Pediatric Cardiology, Vol. 37, No. 3, 01.03.2016, p. 610-617.

Research output: Contribution to journalArticle

Averin, K, Villa, C, Krawczeski, CD, Pratt, J, King, E, Jefferies, J, Nelson, DP, Cooper, DS, Ryan, TD, Sawyer, J, Towbin, J & Lorts, A 2016, 'Initial Observations of the Effects of Calcium Chloride Infusions in Pediatric Patients with Low Cardiac Output', Pediatric Cardiology, vol. 37, no. 3, pp. 610-617. https://doi.org/10.1007/s00246-015-1322-2
Averin, Konstantin ; Villa, Chet ; Krawczeski, Catherine D. ; Pratt, Jesse ; King, Eileen ; Jefferies, John ; Nelson, David P. ; Cooper, David S. ; Ryan, Thomas D. ; Sawyer, Jaclyn ; Towbin, Jeffrey ; Lorts, Angela. / Initial Observations of the Effects of Calcium Chloride Infusions in Pediatric Patients with Low Cardiac Output. In: Pediatric Cardiology. 2016 ; Vol. 37, No. 3. pp. 610-617.
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