Abstract
Objective
To assess the effect of reducing retrieval team response time on the outcomes of babies born outside a cardiac centre (outborn) with antenatally diagnosed transposition of the great arteries.
Study design
Retrospective cohort study of all outborn babies with antenatally diagnosed TGA anticipated to require transfer for urgent balloon atrial septostomy over a 6-year period (15 babies pre intervention and 27 post intervention). The intervention involved a collaborative multicomponent practice change aiming to reduce retrieval team response time.
Result
The mean (SD) time from birth to cardiac ICU arrival was 159 (12) min pre intervention and 103 (6) min post intervention (mean difference −57 min [95% CI, −81 to −32]). There was a significant decrease in need for extracorporeal membrane oxygenation (33% versus 4%), RR 0.11 [95% CI, 0.02–0.65]), with a number needed to treat of 3.4 to prevent one ECMO episode.
Conclusion
Reducing retrieval time is achievable with collaborative systems, and significantly improves clinical outcomes.
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References
Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F. Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adult: 9th ed. Philadelphia: Wolters Kluwer; 2016.
Bonnet D, Coltri A, Butera G, Fermont L, Le Bidois J, Kachaner J, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation. 1999. https://doi.org/10.1161/01.CIR.99.7.916.
Bu’Lock FA. Transporting babies with known heart disease; who, what and where? Arch Dis Child Fetal Neonatal Ed. 2007. https://doi.org/10.1136/adc.2006.101626.
Hutter PA, Kreb DL, Mantel SF, Hitchcock JF, Meijboom EJ, Bennink GBWE. Twenty-five years’ experience with the arterial switch operation. J Thorac Cardiovasc Surg. 2002;124:790–7.
Khoshnood B, De Vigan C, Vodovar V, Goujard J, Lhomme A, Bonnet D, et al. Trends in prenatal diagnosis, pregnancy termination, and perinatal mortality of newborns with congenital heart disease in France, 1983–2000: a population-based evaluation. Pediatrics. 2005. https://doi.org/10.1542/peds.2004-0516.
Komarlu R, Morell VO, Kreutzer J, Munoz RA. Dextro-transposition of the great arteries (D-TGA). In: Munoz R, Morell V, da Cruz E, Vetterly C, da Silva J. editors. Critical Care of Children with Heart Disease. Springer, Cham; 2020. https://doi.org/10.1007/978-3-030-21870-6_32.
Jouannic JM, Gavard L, Fermont L, Le Bidois J, Parat S, Vouhé PR, et al. Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries. Circulation. 2004. https://doi.org/10.1161/01.CIR.0000144141.18560.CF.
Huhta JC. Evaluating the fetus with transposition. Cardiol Young. 2005. https://doi.org/10.1017/S1047951105001095.
Sivanandam S, Glickstein JS, Printz BF, Allan LD, Altmann K, Solowiejczyk DE, et al. Prenatal diagnosis of conotruncal malformations: diagnostic accuracy, outcome, chromosomal abnormalities, and extracardiac anomalies. Am J Perinatol. 2006. https://doi.org/10.1055/s-2006-939535.
Woods P, Browning Carmo K, Wall M, Berry A. Transporting newborns with transposition of the great arteries. J Paediatr Child Health. 2013. https://doi.org/10.1111/jpc.12066.
Paul S, Resnick S, Gardiner K, Ramsay JM. Long-distance transport of neonates with transposition of the great arteries for the arterial switch operation: a 26-year Western Australian experience. J Paediatr Child Health. 2015. https://doi.org/10.1111/jpc.12782.
Blyth M, Howe D, Gnanapragasam J, Wellesley D. The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis. BJOG An Int J Obstet Gynaecol. 2008. https://doi.org/10.1111/j.1471-0528.2008.01793.x.
Whyte HEA, Jefferies AL, Lacaze T, Newhook LA, Hendson L, Lemyre B, et al. The interfacility transport of critically ill newborns. Paediatr Child Heal. 2015;20:265–75.
Browning Carmo KA, Barr P, West M, Hopper NW, White JP, Badawi N. Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation. Arch Dis Child Fetal Neonatal Ed. 2007. https://doi.org/10.1136/adc.2006.096305.
Bairdain S, Betit P, Craig N, Gauvreau K, Rycus P, Wilson JM, et al. Diverse morbidity and mortality among infants treated with venoarterial extracorporeal membrane oxygenation. Cureus. 2015. https://doi.org/10.7759/cureus.263.
Taylor AK, Cousins R, Butt WW. The long-term outcome of children managed with extracorporeal life support: an institutional experience. Crit Care Resusc. 2007;9:172.
Veal C, Hunt R, Tume LN. Do infants with transposition of the great arteries born outside a specialist centre have different outcomes? Cardiol Young. 2019. https://doi.org/10.1017/S1047951119001367.
Hancock S, Harrison C. Establishing a combined neonatal and paediatric transport system from scratch. Curr Treat Options Pediatr. 2018. https://doi.org/10.1007/s40746-018-0110-7.
Hannegård Hamrin T. Inter-hospital transports of critically ill children. Karolinska University Hospital, Solna; 2019. https://openarchive.ki.se/xmlui/handle/10616/46752.
Belway D, Henderson W, Keenan SP, Levy AR, Dodek PM. Do specialist transport personnel improve hospital outcome in critically ill patients transferred to higher centers? A systematic review. J Crit Care. 2006. https://doi.org/10.1016/j.jcrc.2005.12.008.
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AZ acquired patient data, analysed the results, drafted the initial manuscript and approved the final manuscript as submitted. MS conceptualised and designed the study, critically reviewed the manuscript and approved the final manuscript as submitted. CD acquired patient data and approved the final manuscript as submitted. BS conceptualised and designed the study, critically reviewed the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The authors declare that they have no conflict of interest.
Ethics approval
This study was given ethics approval by the Royal Children’s Hospital Melbourne Human Research Ethics Committee (approval ref LNR/18/RCHM/256).
Patient consent
Parents provided written consent for their children’s data to be stored in PIPER and RCH PICU databases for de-identified research use.
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Zayegh, A., Stewart, M., Delzoppo, C. et al. Improving transport time for babies with antenatally diagnosed transposition of the great arteries reduces the need for ECMO. J Perinatol 40, 1570–1575 (2020). https://doi.org/10.1038/s41372-020-0679-0
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DOI: https://doi.org/10.1038/s41372-020-0679-0