[Levosimendan, a new inotropic drug: experience in children with acute heart failure].
BACKGROUND
Low cardiac output syndrome occurs frequently in pediatric patients after cardiac surgery. Catecholamines are used as inotropic drugs to treat this threatening condition, but may cause undesirable and potentially harmful side effects. This study was performed to evaluate the efficacy and safety of levosimendan (LEVO) in pediatric patients with low cardiac output syndrome.


METHODS
Open prospective, quasi-experimental cohort. LEVO was given as compassionate treatment in patients with refractory post-surgical low cardiac output syndrome. Every patient received an IV infusion of LEVO at 6 microg/kg during a fifteen minutes period, followed by a 24 h IV infusion at 0.1 microg/kg/min. Clinical improvement of cardiac output was the primary end point of the study. Two independent observers performed clinical evaluation, bidimensional echocardiogram, hemodynamic and laboratory tests were performed pre and after LEVO infusion.


RESULTS
LEVO was infused in 18 opportunities (fourteen children). The response was considered successful in 9/18 interventions (50%; p= 0.004). Both inotropic score (12.1 vs. 6,1, p= 0.01) and A-VDO(2)2 (26.78 +/- 11.5% vs. 20.81 +/- 7.72%, p= 0.029) showed reduction, while SvO2 improved (69.5 +/- 11.4% vs. 76 +/- 9.29%, p= 0.03). No adverse effects were noticed. Four patients died, none of them related to LEVO administration.


CONCLUSIONS
LEVO improved cardiac output in 50% of the interventions with post-surgical LCOS and no adverse effect was observed.
Magliola
Ricardo
R
Unidad de Cuidados Intensivos UCI 35, Recuperación Cardiovascular, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
Moreno
Guillermo
G
Vassallo
Juan C
JC
Landry
Luis M
LM
Althabe
María
M
Balestrini
María
M
Charroqui
Alberto
A
Salgado
Gladys
G
Lataza
Evangelina
E
Chang
Anthony C
AC
D000208:Acute Disease; D000293:Adolescent; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan