title: Initial Observations of the Effects of Calcium Chloride Infusions in Pediatric Patients with Low Cardiac Output.
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.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. konstantin.averin@cchmc.org.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Averin
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: Chet
authors.initials: C
authors.lastname: Villa
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.|The Heart Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Pratt
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: King
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Jefferies
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Nelson
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Ryan
authors.affiliation: Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Sawyer
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.|The Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Lorts
mesh_terms: D000293:Adolescent; D062186:Arterial Pressure / Q000187:drug effects*; D002122:Calcium Chloride / Q000008:administration & dosage*; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D009820:Ohio; D012189:Retrospective Studies; D013318:Stroke Volume; D055815:Young Adult
chemical_list: D002122:Calcium Chloride
keywords: Cardiogenic shock; Congenital heart disease; Heart failure; Intensive care; Neonates; Vasoactive