Andra Duncan, MD, MS, a cardiac anesthesiologist at Cleveland Clinic, discusses her recently published article titled “Risk factors, resource use, and cost of postoperative low cardiac output syndrome” in the Journal of Thoracic and Cardiovascular Surgery. She emphasizes “the patients with low cardiac output syndrome, or LCOS, are one of the most challenging patients that we take care of.” She and her colleagues undertook this research to understand the risk factors for developing LCOS and the impact of LCOS on resources and cost. She explains that they identified patients with LCOS using two criteria: patients who required mechanical circulatory support (LV assist device, balloon pump or ECMO) within five days of surgery and patients with hemodynamic instability post-operative day one who required prolonged inotropic support with two or more inotropes. “The development of LCOS has a big impact on hospital cost and resource utilization,” she explains, and knowing the risk factors for LCOS can help tailor patient management.