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PP-012 Predictability of central venous to arterial CO2 difference to low cardiac output related outcomes in children with cardiac surgery
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  1. Pornnicha Chaiwiriyawong,
  2. Pharsai Prasertsan,
  3. Jirayut Jarutach,
  4. Kantara Saelim,
  5. Pongsanae Duangpakdee,
  6. Polathep Vichitkunakorn
  1. Prince of Sonklanagarind University, Department of Pediatrics

Abstract

Aim Evaluate the association between VACO2 and poor LCOS-related outcomes in children who underwent cardiac surgery and the correlation of the VACO2 with others bedside surrogates (lactate and oxygen extraction ratio; O2ER)

Material and Method A prospective cohort study was conducted in children aged 0–18 years old with cardiac disease who underwent open cardiac surgery with CPB. Arterial and venous blood gas were collected at time of PICU admission and at 6, 12, and 24-hours post operation. The poor LCOS-related outcomes consisted of two out of five criteria: clinical LCOS, laboratory LCOS, vasopressor-inotropic score ≥ 20, serious interventions, and an ejection fraction <50% on echocardiography

Results From August 2021 to August 2023, 107 children had cardiac surgery. Seven patients were excluded from the study, leaving 100 patients for final analysis. The median age was 30.1 months (3.3, 56.9) and 27.0% (27/100) had a Risk Adjustment in Congenital Heart Surgery ≥ 3. The lactate was only the bedside parameter that showed significant differences between patient with and without poor LCOS related outcomes, while there were no differences of VACO2 and O2ER values between 2 groups. The VACO2 was not correlated with lactate at all timepoints but had fair-to-weak correlated with O2ER at PICU admission and 6-hour post operation (R2 = 0.41; p < 0.001, R2 = 0.58; p < 0.001, R2= 0.15; p = 0.15, R2= 0.29; p = 0.01 at 0, 6, 12, 24 hours post operation, respectively).

Conclusions Central venous-arterial CO2 difference has fair-to-weak correlation with O2ER but not lactate. The higher gap of VACO2 did not associate with poor LCOS-related outcomes, including other morbidities and mortality. This study still encourages to apply lactate level for hemodynamic monitoring in children after cardiac surgery.

  • carbon dioxide
  • thoracic surgery
  • congenital heart disease
  • post operative period

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