King Caitlin E, Thompson Elizabeth J, Foote Henry P, Zimmerman Kanecia O, Hill Kevin D, Chamberlain Reid, Hornik Christoph P
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
Cardiol Young. 2020 Dec;30(12):1757-1771. doi: 10.1017/S1047951120004151. Epub 2020 Nov 20.
Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use.
To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth - 18 years of age. Two reviewers independently reviewed studies to determine final eligibility.
The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses.
Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.
中重度先天性心脏病（CHD）患儿在儿童期常接受体外循环手术。术后发生低心排血量综合征的患儿发病率和死亡率最高。血管活性药物和正性肌力药物是这些患儿治疗的主要手段，尽管支持其使用的证据有限。
为了为临床实践以及未来试验的开展提供信息，我们使用PubMed和EMBASE数据库对心脏手术后儿童使用正性肌力药物和血管活性药物的现有文献进行了系统综述。我们纳入了2000年至2020年的研究，患者人群定义为出生至18岁。两名 reviewers 独立审查研究以确定最终入选资格。
最终分析纳入了37篇论文。总体而言，选定的研究报告了2856名儿童使用的12种不同的血管活性药物和正性肌力药物。支持在体外循环后儿童中使用这些药物的总体证据有限。大多数研究规模较小，37项研究中有30项（81%）纳入的患者少于100名，37项研究中有29项（78%）未进行随机分组，安全性和疗效终点差异很大，限制了合并数据进行荟萃分析的能力。
血管活性和正性肌力支持仍然是体外循环心脏手术后儿童术后护理的关键部分。对于这些患者，关于血管活性药物和正性肌力药物的选择和剂量的数据很少。尽管仍存在知识空白，但最近的众多创新为重新思考在这一高风险人群中开展临床试验创造了机会。
