Hemodynamic response to calcium chloride boluses in single-ventricle patients with parallel circulation

Authors

Fabio Savorgnan, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA.
Saul Flores, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA. saul.flores2@bcm.edu.
Rohit S. Loomba, Advocate Aurora HealthFollow
Paul A. Checchia, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA.Follow
Ronald A. Bronicki, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA.Follow
Juan S. Farias, Tecnologico de Monterrey, Escuela de Medicina Y Ciencias de La Salud, Monterrey, Nuevo Leon, Mexico.
Sebastian Acosta, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA.Follow

Recommended Citation

Savorgnan F, Flores S, Loomba RS, et al. Hemodynamic Response to Calcium Chloride Boluses in Single-Ventricle Patients with Parallel Circulation. Pediatr Cardiol. 2022;43(3):554-560. doi:10.1007/s00246-021-02754-3

Affiliations

The Heart Institute, Advocate Children's Hospital

Abstract

The purpose of this study is to assess the effect of calcium bolus in response to a hypotensive episode by assessing high-fidelity hemodynamic data obtained from children with single-ventricle physiology with parallel circulation. Single-center, retrospective analysis of hemodynamic data after calcium bolus administrations within the first 2 weeks post-surgery. Time intervals were the baseline (- 60 to - 10 min); the hypotensive episode (- 10 to 0 min); time point zero at the bolus administration; and the response (0 to 60 min). The main responses assessed were the peak increase in mean blood pressure (mBP), duration of the response after the bolus, and markers of oximetric effects. These analyses included 128 boluses in 63 patients. Of the total boluses analyzed, 80% increased the mBP by 5 mmHg or higher with the effect lasting at least 10 min, whereas 10% of the boluses analyzed increased the mBP by 20 mmHg or higher with the effect lasting at least 50 min. The boluses induced a significant increase in arterial oxygen saturation and an upward trend in pulmonary-to-systemic flow ratio, without increasing renal or cerebral oxygen extraction ratios. Calcium chloride boluses are an effective rescue medication for hypotensive episodes in children with parallel circulation. They lead to an improvement in mBP, as well as an increase in pulmonary-to-systemic blood flow ratio. More importantly, these boluses do not compromise systemic oxygen delivery.

Document Type

Article

PubMed ID

34652494