{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:22:51Z","timestamp":1783297371469,"version":"3.54.6"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable in identifying a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference\/arterial-venous oxygen difference ratio [P(v-a)CO2\/C(a-v)O2] can be a good index to predict the development of LCOS in the aforementioned patients, so as to treat it promptly. Methods: This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Integrated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analyses were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to the intensive care unit, before and after extubation, and at any time of instability or modification of the patient\u2019s clinical and therapeutic conditions. Results: The data analysis shows that 46.9% of the children developed LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2\/C(a-v)O2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. Conclusions: This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2, and oxygen extraction ratio\u2014ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with hemodynamic instability before surgery.<\/jats:p>","DOI":"10.3390\/jcm12175700","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T09:12:22Z","timestamp":1693559542000},"page":"5700","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Analysis of P(v-a)CO2\/C(a-v)O2 Ratio and Other Perfusion Markers in a Population of 98 Pediatric Patients Undergoing Cardiac Surgery"],"prefix":"10.3390","volume":"12","author":[{"given":"Matteo","family":"Taiana","sequence":"first","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Tomasella","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Russo","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Lerose","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Magalini Hospital ULSS 9 Scaligera, Villafranca, 37069 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Ceola Graziadei","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Corubolo","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Rama","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Schweiger","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Policlinico G.B. Rossi, Hospital and University Trust of Verona, P. le L. Scuro, 37129 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Vignola","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Hospital and University Trust of Verona, P. le A. Stefani, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Polati","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Policlinico G.B. Rossi, Hospital and University Trust of Verona, P. le L. Scuro, 37129 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0931-018X","authenticated-orcid":false,"given":"Giovanni Battista","family":"Luciani","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-3557","authenticated-orcid":false,"given":"Francesco","family":"Onorati","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Donadello","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Policlinico G.B. Rossi, Hospital and University Trust of Verona, P. le L. Scuro, 37129 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Gottin","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1016\/j.jtcvs.2020.09.040","article-title":"Commentary: Low cardiac output syndrome: A definition or a diagnosis code?","volume":"163","author":"Whitson","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1016\/j.athoracsur.2011.06.017","article-title":"Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: Trends over 20 years","volume":"92","author":"Algarni","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.jacc.2015.03.036","article-title":"2015 SCAI\/ACC\/HFSA\/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d\u2019intervention","volume":"65","author":"Rihal","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1161\/01.CIR.51.5.867","article-title":"Cardiac performance and mortality early after intracardiac surgery in infants and young children","volume":"51","author":"Parr","year":"1975","journal-title":"Circulation"},{"key":"ref_5","unstructured":"Johnson, W.H. (2014). Pediatric Cardiology: The Essential Pocket Guide, John Wiley and Sons. [3rd ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1023\/B:JOPA.0000029488.45177.48","article-title":"A population pharmacokinetic analysis of milrinone in pediatric patients after cardiac surgery","volume":"31","author":"Bailey","year":"2004","journal-title":"J. Pharmacokinet. Pharmacodyn."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1097\/CCM.0b013e318275cece","article-title":"Lactate and venoarterial carbon dioxide difference\/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders","volume":"41","author":"Monnet","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.4103\/0366-6999.156770","article-title":"The Use of the Ratio between the Veno-arterial Carbon Dioxide Difference and the Arterial-venous Oxygen Difference to Guide Resuscitation in Cardiac Surgery Patients with Hyperlactatemia and Normal Central Venous Oxygen Saturation","volume":"128","author":"Du","year":"2015","journal-title":"Chin. Med. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S0140-6736(05)71045-X","article-title":"Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: A prospective study","volume":"365","author":"Levy","year":"2005","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0749-0704(05)70161-5","article-title":"Cytopathic hypoxia. Mitochondrial dysfunction as mechanism contributing to organ dysfunction in sepsis","volume":"17","author":"Fink","year":"2001","journal-title":"Crit. Care Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/S0022-5223(20)31463-X","article-title":"Trauma metabolism and the heart. Uptake of substrates and effects of insulin early after cardiac operations","volume":"99","author":"Svensson","year":"1990","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1378\/chest.102.6.1787","article-title":"Venous hyperoxia after cardiac arrest. Characterization of a defect in systemic oxygen utilization","volume":"102","author":"Rivers","year":"1992","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1001\/jama.1988.03410050082034","article-title":"\u2018Lactate washout\u2019 following circulatory arrest","volume":"260","author":"Leavy","year":"1988","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1007\/s00134-013-2888-x","article-title":"Central venous-arterial pCO2 difference as a tool in resuscitation of septic patients","volume":"39","author":"Lont","year":"2013","journal-title":"Intensive Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00134-015-3720-6","article-title":"Combination of arterial lactatelevels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock","volume":"41","author":"Hernandez","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_16","first-page":"640","article-title":"Venoarterial PCO2 difference: A marker of postoperative cardiac output in children with congenital heart disease","volume":"19","author":"Furqan","year":"2009","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/PCC.0000000000001085","article-title":"Central Venous to Arterial CO2 Difference after Cardiac Surgery in Infants and Neonates","volume":"18","author":"Rhodes","year":"2017","journal-title":"Pediatr. Crit Care Med."},{"key":"ref_18","first-page":"UC22","article-title":"Monitoring Microcirculatory Blood Flow during Cardiopulmonary Bypass in Paediatric Cardiac Surgery Patients as a Predictor for Anaerobic Metabolism","volume":"11","author":"Patel","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s00134-002-1215-8","article-title":"Combination of venoarterial PCO2 difference with arteriovenous O2 content difference to detect anaerobic metabolism in patients","volume":"28","author":"Castelain","year":"2002","journal-title":"Intensive Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13613-017-0288-z","article-title":"Venoarterial PCO2-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: An experimental study","volume":"7","author":"Dubin","year":"2017","journal-title":"Ann. Intensive Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"973147","DOI":"10.3389\/fmed.2022.973147","article-title":"Prediction of low cardiac output syndrome in patients following cardiac surgery using machine learning","volume":"9","author":"Hong","year":"2022","journal-title":"Front. Med."},{"key":"ref_22","first-page":"504","article-title":"\u00c7ocuk yo\u011fun bak\u0131m \u00fcnitesinde kardiyak cerrahi sonras\u0131 hastalar\u0131n de\u011ferlendirilmesinde kullan\u0131lan d\u00fc\u015f\u00fck kardiyak debi sendromu skorlamas\u0131 [Low cardiac output syndrome score to evaluate postoperative cardiac surgery patients in a pediatric intensive care unit]","volume":"48","author":"Aslan","year":"2020","journal-title":"Turk. Kardiyol. Dern. Ars."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.thromres.2021.12.024","article-title":"Is bivalirudin an alternative anticoagulant for extracorporeal membrane oxygenation (ECMO) patients? A systematic review and meta-analysis","volume":"210","author":"Li","year":"2022","journal-title":"Thromb. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1111\/aor.14276","article-title":"Use of nafamostatmesilate for anticoagulation during extracorporeal membrane oxygenation: A systematic review","volume":"46","author":"Sanfilippo","year":"2022","journal-title":"Artif. Organs"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"La Via, L., Sanfilippo, F., Continella, C., Triolo, T., Messina, A., Robba, C., Astuto, M., Hernandez, G., and Noto, A. (2023). Agreement between capillary refill time measured at finger and earlobe sites in different positions: A pilot prospective study on healthyvolunteers. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-022-01920-1"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1164\/rccm.202204-0687OC","article-title":"Performance of Early Capillary Refill Time Measurement on Outcomes in Cardiogenic Shock: An Observational, Prospective Multicentric Study","volume":"206","author":"Merdji","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5700\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:44:38Z","timestamp":1760129078000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":26,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jcm12175700"],"URL":"https:\/\/doi.org\/10.3390\/jcm12175700","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,1]]}}}