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Treatment for paediatric low cardiac output syndrome: results from the European EuLoCOS-Paed survey


Objective To characterise current hospital practice and use of prescribing resources related to drug treatment for low cardiac output syndrome (LCOS) in children with open heart surgery (OHS) in Europe.

Design A web-based questionnaire survey (EuLoCOS-Paed) conducted between January and August 2009.

Setting European hospitals performing OHS in children.

Results 90 out of 125 hospitals (72%) from 31 European countries responded to the questionnaire. The initial treatment and two add-on steps reported were analysed for: (i) LCOS with elevated systemic vascular resistance (SVR), where milrinone (34% of reports), epinephrine (24%) and epinephrine/levosimendan (22%) were favoured; (ii) LCOS with low SVR, where dopamine (20%), epinephrine (29%) and norepinephrine (24%) were dominant; and (iii) LCOS with elevated pulmonary vascular resistance, where milrinone (17%), inhaled nitric oxide (20%) and prostacyclin derivatives (22%) were preferred. Overall, milrinone, epinephrine, dopamine and dobutamine were used in over 50% of the reported drug regimens for treating LCOS. The availability of drug and dosing information for prescribing was stated to be insufficient by 40% of participants, while 88% would appreciate clinical practice guidelines.

Conclusion Drug treatment for LCOS in children with OHS across Europe is highly variable, possibly partly reflecting the lack of evidence and prescribing standards on the use of medicines. Milrinone, epinephrine, dopamine and dobutamine are mostly used, and should be prioritised for future research on LCOS treatment. Such research should be aimed at increasing the level of evidence for clinical practice guidelines to improve the standard of care.

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