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welcome to world shared practices forum Im dr. Jeff burns chief of critical care at Boston Childrens Hospital and Harvard Medical School were very pleased to have with us today dr. Steve Schwartz dr. Schwartz is chief of the division of cardiac critical care medicine at the Hospital for Sick Children in Toronto and professor of pediatrics at the University of Toronto Steve welcome thanks Jeff really happy to be here Steve my first question for you is this colleagues around the world I suspect like I have an intuitive framework about our approach to low cardiac output syndrome but youve been doing this for twenty years in some of the highest volume cardiac intensive care units in the world how should we structure our framework in thinking about the child with low cardiac output syndrome so when I start to think of the framework then of how I apply treatment to these patients really you can ask the question what is heart failure in the ICU so we all know the definition that we learn