Key result
High 48-hour VIS linked to ~21-fold higher odds of poor outcomes after pediatric congenital heart surgery.
Why the study?
Although studies showed the vasoactive-inotropic score (VIS) correlates with morbidity and mortality after pediatric cardiac surgery, conclusions remained not completely unified.
Does a high vasoactive-inotropic score predict poor clinical outcomes in children undergoing cardiac surgery with extracorporeal circulation?
Cohort (n=100)
No
Does a high vasoactive-inotropic score predict poor clinical outcomes in children undergoing cardiac surgery with extracorporeal circulation?
Odds Ratio: 20.6 (95% CI 5.9–71.7)
Absolute Event Rate: 55.2% vs 5.6%
p-value: p=<0.001
A high vasoactive-inotropic score in the first 48 hours after pediatric congenital heart surgery with cardiopulmonary bypass is a useful predictor of poor clinical outcomes and prolonged intensive care requirements.
May support risk stratification after pediatric congenital heart surgery; leaves open need for prospective validation before practice change.
Objectives: Many authors showed that the VIS (vasoactive-inotropic score) has a strong correlation with morbidity and mortality after cardiac surgery in children, but the conclusions are not completely unified. We therefore performed this study to determine the relationship between the VIS score and clinical outcomes in children undergoing cardiac surgery with extracorporeal circulation. Method: Prospective cohort study. A total of 100 pediatric patients from birth to 2 years of age with indications for cardiac surgery with extracorporeal circulation at the Anesthesiology Department of the Heart Institute of Ho Chi Minh City from January 1, 2021, to December 31, 2021, were included in the study. Hourly doses of all vasoactive medications were recorded for the first 48 hours after admission to cardiothoracic intensive care unit and a vaso-active inotropic score was calculated. The VIS scale is calculated by the formula: VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 × adrenaline dose (µg/kg/min) + 10 × milrinone dose (µg/min) kg/min) + 10000 × vasopressin dose (U/kg/min) + 100 × noradrenaline dose (µg/kg/min). The max and mean values of VIS in the first 24 hours and the max and mean values of VIS in the subsequent 24 hours after admission (from 25th to 48th hour) were calculated. Results: The rate of patients with low cardiac output syndrome was 38.0%. There were 20/100 cases (20.0%) with a poor outcome, of which 19 cases required peritoneal dialysis, 4/100 cases (4.0%) had cardiac arrest, 2/100 cases (2.0%) had seizures, 1/100 (1.0%) had to run ECMO and 4/100 (4.0%) died after surgery. Patients in the high VIS group (mean 48- hour VIS ≥ 11.06) compared with the low VIS group (mean 48- hour VIS < 11.06) were associated with prolonged duration of mechanical ventilation, prolonged CICU length of stay in the ICU, prolonged time to negative fluid balance. Conclusions: The high VIS after surgery was a good predictor of a poor clinical outcome, prolonged duration of mechanical ventilation, prolonged CICU length of stay outcomes in children undergoing cardiac surgery with extracorporeal circulation
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Hoang et al. (2023) conducted a cohort in Congenital heart disease requiring surgery with cardiopulmonary bypass (n=100). High Vasoactive-Inotropic Score (mean 48-hour VIS ≥ 11.06) vs. Low Vasoactive-Inotropic Score (mean 48-hour VIS < 11.06) was evaluated on Poor clinical outcome (composite of death, cardiac arrest, ECMO, peritoneal dialysis, or central nervous system injury) (OR 20.6, 95% CI 5.9-71.7, p=<0.001). A high mean 48-hour Vasoactive-Inotropic Score (≥ 11.06) was strongly associated with a poor clinical outcome in children after congenital heart surgery (OR 20.6).
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