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Sahulee et al. Vessel Plus 2022;6:5 Vessel Plus
DOI: 10.20517/2574-1209.2021.94

Review Open Access

Pharmacologic therapies for the low cardiac output

syndrome in children after cardiac surgery: evidence
of their efficacy and trends in their use

Raj Sahulee, Jaclyn McKinstry

Department of Pediatrics, Division of Cardiology, NYU Grossman School of Medicine, New York, NY 10019, USA.
Correspondence to: Dr. Raj Sahulee, Department of Pediatrics, Division of Cardiology, NYU Grossman School of Medicine, 403 E
34th St, Rivergate B-406, New York, NY 10019, USA. E-mail: Raj.Sahulee@nyumc.org
How to cite this article: Sahulee R, McKinstry J. Pharmacologic therapies for the low cardiac output syndrome in children after
cardiac surgery: evidence of their efficacy and trends in their use. Vessel Plus 2022;6:5. https://dx.doi.org/10.20517/2574-
1209.2021.94

Received: 2 Jul 2021 First Decision: 19 Aug 2021 Revised: 26 Aug 2021 Accepted: 17 Sep 2021 Published: 6 Jan 2022
Academic Editors: P. Syamasundar Rao, Alexander D. Verin Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
The low cardiac output syndrome describes the phenomenon of the reduction of cardiac output that can occur
following cardiac surgery requiring cardiopulmonary bypass. If unrecognized or untreated, this condition can result
in significant morbidity and mortality. Along with non-pharmacologic therapies, pharmacologic agents used to help
manage the low cardiac output syndrome include catecholamine inotropes, inodilators, systemic vasodilators,
pulmonary vasodilators, and other classes of medications. We summarize the rationale and key evidence
supporting the use of these therapies in children. In addition, utilizing provider surveys and registry reviews, we
describe the current trends in the use of these medications and the variation demonstrated between providers and
centers. Given the heterogeneous etiology of low cardiac output syndrome, successful management requires that
pharmacologic therapies be tailored to the physiologic derangements of each patient.

Keywords: Cardiac surgery, low cardiac output syndrome, pediatrics, cardiac critical care

INTRODUCTION
The low cardiac output syndrome (LCOS) is generally described as the self-limited reduction of cardiac
output that can occur in the first 24 h after cardiac surgeries requiring cardiopulmonary bypass (CPB).
Although there is no strict, unified definition, the phenomenon is well recognized and described. The result

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