Key result
Among 43,441 postoperative pediatric cardiac admissions, milrinone was the only vasoactive agent independently associated with decreased inpatient mortality (OR 0.37).
Why the study?
The study sought to examine variation in vasoactive agent prescription patterns and determine the association between the number of vasoactive agents used and admission characteristics across a large cohort.
Does the use of specific vasoactive agents affect inpatient mortality in postoperative pediatric cardiac patients?
Cross-Sectional (n=43,441)
Yes
Does the use of specific vasoactive agents affect inpatient mortality in postoperative pediatric cardiac patients?
In postoperative pediatric cardiac patients, the use of vasoactive agents has generally decreased over time, and only milrinone is independently associated with decreased inpatient mortality.
Answers are grounded in this paper and cite their sources.
Does not support practice change; leaves open need for randomized confirmation in pediatric cardiac surgery.
OBJECTIVE: The main goal of this study is to examine the variation in vasoactive agent prescription patterns across a large cohort of patients. In addition, we sought to determine the association between the number of vasoactive agents used during admissions and characteristics of admissions utilizing varying numbers of vasoactive agents. METHODS: This was a multi-institutional, cross-sectional study of the pediatric health information system database of patients who underwent congenital heart surgery and received vasoactive agents from 2004 to 2015. The international classification of disease-9 (ICD-9) codes were used to select admissions to those only pertaining to cardiac patients. The vasoactive agents investigated included epinephrine, norepinephrine, dopamine, dobutamine, milrinone, and vasopressin. RESULTS: A total of 43 441 postoperative pediatric cardiac admissions were identified and included in the final analyses. Of these, a majority used at least one vasoactive agent at some point during the admissions with the median being three vasoactives. Each vasoactive was utilized with decreasing frequency throughout the study period except for vasopressin which increased in frequency of use. After adjusting for multiple confounding factors, only milrinone was associated with decreased inpatient mortality in any postoperative subset, while the rest of the vasoactive were associated with increased inpatient mortality in some of the postoperative subsets. CONCLUSION: Vasoactive agents have decreased in frequency of use in postoperative pediatric cardiac admissions, except for vasopressin. Only milrinone was found to be associated with decreased inpatient mortality in any subset of these patients, while all other vasoactive agents were found to be associated with increased inpatient mortality at least in one of the subsets.
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Loomba et al. (2019) conducted a cross-sectional in Postoperative congenital heart disease (n=43,441). Milrinone vs. Non-use of milrinone was evaluated on Inpatient mortality (OR 0.37, 95% CI 0.30-0.47). Among 43,441 postoperative pediatric cardiac admissions, milrinone was the only vasoactive agent independently associated with decreased inpatient mortality (OR 0.37).
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