Infants with Single Ventricle Physiology in the Emergency Department: Are Physicians Prepared?

Cashen, Katherine; Gupta, Pooja; Lieh-Lai, Mary; Mastropietro, Christopher W.

doi:10.1016/j.jpeds.2011.01.031

Cited by 20 publications

(30 citation statements)

References 13 publications

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“…A recent survey of 376 emergency department physicians determined that most (72%) were unsure of the acceptable range of arterial oxygen saturation for infants with a single ventricle, and 58% were “uncomfortable” or “worried” about their treatment. 21 Despite these concerns, 59% deemed education in single ventricle physiology as low priority, likely due to the low frequency of encounters with these unique patients.…”

Section: Discussionmentioning

confidence: 99%

Cause, timing, and location of death in the Single Ventricle Reconstruction trial

Ohye

Schonbeck

Eghtesady

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

116

103

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Objectives The Single Ventricle Reconstruction trial randomized 555 subjects with a single right ventricle undergoing the Norwood procedure at 15 North American centers to receive either a modified Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt. Results demonstrated a rate of death or cardiac transplantation by 12 months postrandomization of 36% for the modified Blalock-Taussig shunt and 26% for the right ventricle-to-pulmonary artery shunt, consistent with other publications. Despite this high mortality rate, little is known about the circumstances surrounding these deaths. Methods There were 164 deaths within 12 months postrandomization. A committee adjudicated all deaths for cause and recorded the timing, location, and other factors for each event. Results The most common cause of death was cardiovascular (42%), followed by unknown cause (24%) and multisystem organ failure (7%). The median age at death for subjects dying during the 12 months was 1.6 months (interquartile range, 0.6 to 3.7 months), with the highest number of deaths occurring during hospitalization related to the Norwood procedure. The most common location of death was at a Single Ventricle Reconstruction trial hospital (74%), followed by home (13%). There were 29 sudden, unexpected deaths (18%), although in retrospect, 12 were preceded by a prodrome. Conclusions In infants with a single right ventricle undergoing staged repair, the majority of deaths within 12 months of the procedure are due to cardiovascular causes, occur in a hospital, and within the first few months of life. Increased understanding of the circumstances surrounding the deaths of these single ventricle patients may reduce the high mortality rate. (J Thorac Cardiovasc Surg 2012;144:907-14)

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Section: Discussionmentioning

confidence: 99%

Cause, timing, and location of death in the Single Ventricle Reconstruction trial

Ohye

Schonbeck

Eghtesady

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

116

103

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“…There are several types of cardiac defects which have single functioning ventricle and these include hypoplastic left heart syndrome, tricuspid atresia, single ventricle, unbalanced atrioventricular canal defects and others. The common finding among these defects is that the heart has only one functioning ventricle, and this ventricle pumps blood to both the body and lungs [14][15][16][17]. Treatment of these defects requires a three-staged surgical approach, beginning in the neonatal period and completed between 2 and 4 years of age [14][15][16][17].…”

Section: Cardiac Emergencies In the Patient With A Functional Single mentioning

confidence: 99%

“…These intercurrent illnesses do cause significant interstage mortality [28]; this is much higher between Stage I and II than between Stage II and III. In order to maximize successful outcomes, emergency physicians should be prepared to assess and treat acutely ill children with palliated single ventricle physiology [16]. Even minor illnesses must be treated aggressively.…”

Section: Stage IIImentioning

confidence: 99%

Pediatric Cardiac Emergencies

Yates

P²

2013

Emergency Medicine

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“…These abnormalities affect the function of the heart and increase the predisposition of these patients to acute deterioration in the setting of many common childhood illnesses, while also altering their response to conventional resuscitative therapies 1. Advances in diagnosis, intervention and management have improved the survival of these children, and most now live in diverse communities, often remote to subspecialised care 2–11. Therefore, when acutely ill, these patients present to community hospitals and emergency departments where the expertise to understand their complex heart disease may be limited.…”

Section: Introductionmentioning

confidence: 99%

“…Many of these children present with heart failure symptoms that can be difficult to distinguish from more common childhood illnesses, and this, in turn, can lead to delays in diagnosis or inappropriate treatment 5 12–16. A survey of emergency department physicians in the state of Michigan revealed that nearly 72% were unsure of what the appropriate oxygen level in the blood should be in a patient with complex heart disease (one ventricle and normally cyanosed), and 58% worried and were uncomfortable caring for these patients 8…”

Section: Introductionmentioning

confidence: 99%

Mixed-methods approach to understanding clinician macrocognition in the design of a clinical decision support tool: a study protocol

2020

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IntroductionThe anatomic variants of congenital heart disease (CHD) are multiple. The increased survival of these patients and disposition into communities has led to an increase in their acute presentation to non-CHD experts in primary care clinics and emergency departments. Given the vulnerability and fragility of these patients in the face of acute illness, new clinical decision support systems (CDSS) are urgently needed to better translate the best practice recommendations for the care of these patients. This study aims to understand the perceived confidence and macrocognitive processes of non-CHD experts (emergency medicine physicians) and CHD experts (paediatric cardiac intensivists) when treating children with CHD during acute illness and apply this to optimise the design of a CDSS (MyHeartPass™) for these patients.Methods and analysisThe first phase of the study involves a survey of non-CHD experts and CHD experts to understand their perceived confidence as it relates to treating acutely ill patients with CHD. The second phase is a qualitative cognitive task analysis using critical decision method to characterise and compare the macrocognitive processes used by non-CHD experts and CHD experts during the critical decision making. In phases 3 and 4, heuristic evaluation and usability testing of the CDSS will be completed. These results will be used to inform design changes to the chosen CDSS (MyHeartPass™). In the final phase, a within-participant simulation design will be used to study the effect of the CDSS on clinical decision making compared with baseline (without use of CDSS).Ethics and disseminationEthics approval from The Hospital for Sick Children in Toronto, Ontario, Canada has been obtained for all phases. Results will be published in peer-reviewed journals and presented at relevant conferences. On successful completion of these studies, it is anticipated that there will be a controlled implementation of the redesigned CDSS.

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Infants with Single Ventricle Physiology in the Emergency Department: Are Physicians Prepared?

Cited by 20 publications

References 13 publications

Cause, timing, and location of death in the Single Ventricle Reconstruction trial

Cause, timing, and location of death in the Single Ventricle Reconstruction trial

Pediatric Cardiac Emergencies

Mixed-methods approach to understanding clinician macrocognition in the design of a clinical decision support tool: a study protocol

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