Failure to Rescue in Humanitarian Congenital Cardiac Surgery

Wallen, Tyler; Fults, Marci; Fariha, Nwaukoni J.; Le, Marilyn; Blenden, Randa; Soto, Rodrigo

doi:10.1016/j.athoracsur.2019.09.022

Cited by 3 publications

(4 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study also yielded this nding, where even though our mortality rate (7.5%) and complication rate (65%) were higher compared to other studies, we were able to attain a comparable FTR rate (11%) to high-income countries' health institutions (Fig. 1) [6,12].…”

Section: Discussionsupporting

confidence: 76%

Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

Cruz,

Pedroza,

Vélez

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Failure to rescue has been an effective quality metric in congenital heart surgery. Conversely, morbidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance. We aim to measure the complications, mortality, and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a low-income country and compare it with other institutions that have conducted a similar study.Methods A retrospective observational study was conducted in a high-complexity service provider institution, in Cali, Colombia. All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included. The main outcomes evaluated in the study were complication, mortality, and failure to rescue rate. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results We evaluated 308 congenital heart surgeries. Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4%. The presence of a postoperative complication (OR 14.88, CI 3.06-268.37, p = 0.009), age (OR 0.79, CI 0.57–0.96, p = 0.068), and urgent/emergent surgery (OR 8.14, CI 2.97–28.66, p < 0.001) were the most significant variables in predicting mortality.Conclusions Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries. Despite our higher mortality and complication rate, we obtained a comparable failure to rescue rate to high-income countries' health institutions.

show abstract

Section: Discussionsupporting

confidence: 76%

Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

Cruz,

Pedroza,

Vélez

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Research shows that the CPB time has a bearing on the postoperative stay in the ICU, time of hospitalization stay and mortality, especially for patients with poor preoperative physical conditions [31,32]. In our study, EPO only curtail the time of mechanical ventilation and stay in the ICU.…”

Section: Limitationmentioning

confidence: 63%

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Lin

Cui

et al. 2020

Med Sci Monit

View full text Add to dashboard Cite

Background:Lung injury after cardiopulmonary bypass (CPB) is a serious postoperative complication and can affect the postoperative recovery. The purpose of this study was to explore whether erythropoietin (EPO) has an effect on lung injury caused by CPB. Material/Methods:Sixty patients who received the CPB were randomly divided into a saline group and the EPO group. All the patients received saline or EPO preoperatively, respectively. The ventilation function, including dynamic compliance, peak airway pressure, and plateau pressure, were recorded. The level of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, and IL-10 in serum and arterial blood gas were analyzed. The mechanical ventilation time in the intensive care unit (ICU), the length of time spent in the ICU, the time from operation to discharge, and the total time of hospitalization were recorded. Adverse events in the ICU were monitored and recorded. Results:EPO significantly decreased the level of TNF-a and IL-1b, but increased the level of IL-10 after CPB. EPO significantly improved pulmonary ventilated function and gas exchange function after CPB. EPO significantly shortened the mechanical ventilation time and stay in the ICU. Conclusions:Preoperative EPO injection reduced lung injury and promoted lung function in patients who underwent CPB.The protection effect of EPO may be associated with inhibition of inflammatory response.

show abstract

“…Mid-term survival was good with 68 out of 70 patients alive at the time of follow-up, which was significantly higher than the 5-year survival rates of 80% to 90% reported by other humanitarian pediatric cardiac surgery programs. 10,29,30 This discrepancy may be due to earlier surgical eras, 29 less consistent follow-up care in the patients’ home countries, and/or more severe CHD. 10,30 After returning to their home countries, most of our patients received continued medical care by local pediatricians or pediatric cardiologists, which is essential for timely recognition of new or progressing cardiac problems, enabling initiation of further cardiovascular procedures when necessary.…”

Section: Discussionmentioning

confidence: 99%

“…10,29,30 This discrepancy may be due to earlier surgical eras, 29 less consistent follow-up care in the patients' home countries, and/or more severe CHD. 10,30 After returning to their home countries, most of our patients received continued medical care by local pediatricians or pediatric cardiologists, which is essential for timely recognition of new or progressing cardiac problems, enabling initiation of further cardiovascular procedures when necessary.…”

Section: Mid-term Survival and Socioeconomic Participationmentioning

confidence: 99%

Benefit From a Humanitarian Pediatric Congenital Heart Surgery Program Over a 10-Year Period

Fürniss

Leutwyler

Zürn

et al. 2023

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background: The charity organization Kinderherzen retten e.V. (KHR) enables humanitarian congenital heart surgery for pediatric patients from low- and middle-income countries at the University Heart Center Freiburg, Germany. The aim of this study was to assess periprocedural and mid-term outcomes of these patients for evaluation of KHR sustainability. Methods: Part one of the study comprised retrospective medical chart analyses of the periprocedural course of all KHR-treated children from 2008 to 2017, and part two a prospective evaluation of their mid-term outcome, assessed by questionnaires concerning survival, medical history, mental and physical development, and socioeconomic situation. Results: Of the 100 consecutively presented children from 20 countries (median age 3.25 years), 3 patients were not invasively treatable, 89 underwent cardiovascular surgery, and 8 received a catheter intervention only. There were no periprocedural deaths. Median postoperative duration of mechanical ventilation, intensive care stay, and total hospital stay was 7 (interquartile range [IQR] 4-21) hours, 2 (IQR 1-3) days, and 12 (IQR 10-16) days, respectively. Mid-term postoperative follow-up demonstrated a 5-year survival probability of 94.4%. The majority of patients received continued medical care in their home country (86.2% of patients), were in good mental and physical condition (96.5% and 94.7% of patients, respectively), and able to engage in age-appropriate education/employment (98.3% of patients). Conclusions: Cardiac, neurodevelopmental, and socioeconomic outcomes of patients treated via KHR was satisfactory. Thorough pre-visit evaluation and close contact with local physicians are crucial when providing this high-quality, sustainable, and viable therapeutic option for these patients.

show abstract

Failure to Rescue in Humanitarian Congenital Cardiac Surgery

Cited by 3 publications

References 15 publications

Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Benefit From a Humanitarian Pediatric Congenital Heart Surgery Program Over a 10-Year Period

Contact Info

Product

Resources

About