Improving outcomes & quality through collaboration

The Pediatric Cardiac Critical Care Consortium (PC⁴) aims to improve the quality of care to patients with critical pediatric and congenital cardiovascular disease.

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The Pediatric Cardiac Critical Care Consortium (PC⁴) aims to improve the quality of care to patients with critical pediatric and congenital cardiovascular disease in North America and abroad. Formed in 2009 with National Institutes of Health funding, PC⁴ is a unique collaborative of leaders in pediatric cardiac critical care, cardiac surgery, and cardiology representing a diverse group of over 70 children’s hospitals across the globe caring for these vulnerable patients. The core pillars of collaborative quality improvement serve as the foundation for PC⁴. Using these pillars, we have been able to improve a variety of outcomes in these children, including the prevention of complications, such as cardiac arrest, and saving hundreds of children’s lives in our member centers.

News & Science

The latest clinical research published in the field pediatric cardiac critical care or referencing PC⁴ registry data

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units
Mueller D, Bailly DK, Banerjee M, Bertrandt RA, Borasino S, Briceno-Medina M, Chan T, Diddle JW, Domnina Y, Clarke-Myers K, Connelly C, Florez A, Gaies M, Garza J, Ghassemzadeh R, Lane J, McCammond AN, Olive MK, Ortmann L, Prodhan P, Raymond TT, Sasaki J, Scahill C, Schroeder LW, Schumacher KR, Werho DK, Zhang W, Alten J and
The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined.
Practice variation in therapeutic hypothermia for hypoxic ischemic encephalopathy among neonates with congenital heart disease in the United States
Chawla V, Peluso AM, Ball MK, Tabbutt S, Bailly DK, Mueller D, Rao R, Levy PT and
Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality
Brunetti MA, Gaynor JW, Zhang W, Banerjee M, Domnina YA and Gaies M
It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.
Pleural Drainage, Clinical Characteristics, and Management Strategies in the Perioperative Fontan Patient: A Multicenter Report
Duran SR, Winder M, Reeder RW, Plummer ST, Sznycer-Taub N, Savoca M, DiMaria MV, Gordon EE, Bhaskar P, Raymond TT, Das A, Tortorich A, Lyman A, Bertrandt RA, Kozyak BW, Frank DU, Greiten LE, Bailly DK and Lay AS
Prolonged pleural drainage and chylothorax are common in postoperative Fontan patients and are associated with increased morbidity and mortality. Multiple medical and interventional treatment strategies exist and vary between centers. This is a retrospective multicenter observational cohort study of pediatric patients who underwent Fontan operation at 8 pediatric cardiac surgical institutions from 1/1/2019 to 12/31/2021. Data were obtained from institutional records and collected from the Pediatric Cardiac Critical Care Consortium (PC). 185 patients underwent Fontan operation with median age of 3.8 years [IQR 3.2-4.5]. Chest tube drainage for > 14 days occurred in 40 patients (22%). Chylothorax occurred in 33 patients (18%, incidence 9.1-26.2% across centers). Compared to non-chylothorax patients, those with chylothorax had lower preoperative ventricular end diastolic pressures (8 vs. 9 mm Hg, p = 0.019), greater chest tube utilization (13 vs. 7 days, p =  < 0.001), ICU LOS (7 vs. 4 days, p = 0.001), hospital LOS (12 vs. 9 days, p < 0.001), and more weight loss (- 2.7% vs. 0.8%, p = 0.019). Using a receiver-operating characteristic curve, chest tube output > 18.8 mL/kg/day on POD 2 predicted chylothorax with an AUC of 0.73. Common chylothorax treatments were diet modification (n = 15, 45%) and sildenafil (n = 14, 52%). Interventional procedures were used in six chylothorax patients (18%). Postoperative chylothorax in Fontan patients was associated with increased chest tube utilization, postoperative interventions, greater weight loss, and longer ICU and hospital LOS. Center level variation suggests outcomes and resource utilization could be improved with further studies and establishment of best practices.
Best practice peri-extubation bundle reduces neonatal and infant extubation failure after cardiac surgery
Todd Tzanetos D, Bassi H, Furlong-Dillard J, Mastropietro C, Olive M, Klugman D and Werho D
Extubation failure after neonatal cardiac surgery is associated with increased intensive care unit length of stay, morbidity, and mortality. We performed a quality improvement project to create and implement a peri-extubation bundle, including extubation readiness testing, spontaneous breathing trial, and high-risk criteria identification, using best practices at high-performing centers to decrease neonatal and infant extubation failure by 20% from a baseline of 15.7% to 12.6% over a 2-year period.

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