Terlipressin for Children with Extremely Low Cardiac Output After Open Heart Surgery

Abstract

Background: Terlipressin, a long-acting analog of vasopressin, has been used successfully in patients with extremely low cardiac output, but its application in children following open heart surgery is limited. Objective: To describe our experience using terlipressin in children with extremely low cardiac output after open heart surgery. Methods: Records were reviewed of all pediatric patients between January 2003 and December 2005 who had undergone open heart surgery, experienced extremely low cardiac output, and were treated with terlipressin as rescue therapy. Mean arterial blood pressure, heart rate, urine output, and lactate and oxygenation index values were retrieved and analyzed when available. Results: Twenty-nine children who were considered gravely ill despite conventional vasoactive agents received terlipressin as rescue therapy, which rapidly yielded significant improvements in all measured hemodynamic and respiratory indices. Mean ± SD arterial blood pressure increased significantly, from 49 ± 17 to 57 ± 16 mm Hg after 10 minutes (p = 0.004) and to 64 ± 15 mm Hg 24 hours after treatment onset (p = 0.001). Twenty-four hours following terlipressin administration, urine output increased from 1.5 ± 2.1 to 3.0 ± 2.3 mL/kg/h (p = 0.001), the oxygenation index decreased from 16.5 ± 27.9 to 9.5 ± 16.7 in the survivors (p = 0.023), and the inotropic score decreased from 41.9 ± 19.9 to 32.6 ± 18.8 (p = 0.009). Conclusions: Terlipressin caused significant improvement in hemodynamic, respiratory, and renal indices in children with extremely low cardiac output after open heart surgery. Further controlled studies are needed to confirm the drug's safety and efficacy in this population.