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Hemodynamic Response to Calcium Chloride Boluses in Single-Ventricle Patients with Parallel Circulation
Fabio Savorgnan1, Saul Flores2, Rohit S Loomba3
1Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Lester A. Smith Legacy Tower, 6651 Main Street, 14th floor, Houston, TX, 77030, USA.
Pediatric Cardiology
|October 15, 2021
Summary
Calcium chloride boluses effectively treat hypotension in children with single-ventricle physiology. This intervention improves blood pressure and circulation without compromising oxygen delivery, offering a vital rescue option post-surgery.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Critical Care Medicine
Background:
- Children with single-ventricle physiology and parallel circulation face unique hemodynamic challenges, particularly post-surgery.
- Hypotensive episodes in this vulnerable population require prompt and effective interventions.
- The role of calcium bolus administration in managing such episodes needs precise evaluation.
Purpose of the Study:
- To assess the efficacy of calcium bolus in response to hypotensive episodes in pediatric patients with single-ventricle physiology.
- To analyze high-fidelity hemodynamic data to understand the impact of calcium on mean blood pressure (mBP) and oxygenation.
- To evaluate the duration and magnitude of hemodynamic response to calcium administration.
Main Methods:
- Retrospective analysis of hemodynamic data from 63 pediatric patients undergoing surgery for single-ventricle physiology.
- Inclusion of 128 calcium chloride bolus administrations within the first two weeks post-surgery.
- Detailed assessment of hemodynamic parameters including mean blood pressure (mBP), arterial oxygen saturation, and pulmonary-to-systemic flow ratio at defined time intervals.
Main Results:
- 80% of calcium boluses increased mean blood pressure (mBP) by at least 5 mmHg for a minimum of 10 minutes.
- 10% of boluses resulted in an mBP increase of 20 mmHg or higher, sustained for at least 50 minutes.
- Significant improvements in arterial oxygen saturation and a trend towards increased pulmonary-to-systemic flow ratio were observed, without adverse effects on renal or cerebral oxygen extraction.
Conclusions:
- Calcium chloride boluses serve as an effective rescue medication for managing hypotensive episodes in children with parallel circulation.
- The intervention demonstrably improves mean blood pressure (mBP) and enhances pulmonary-to-systemic blood flow ratio.
- Importantly, calcium administration does not compromise systemic oxygen delivery, highlighting its safety profile in this context.
