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2. Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury

Author

Fishbein, Jennifer E., Barone, Matthew, Schneider, James B., Meyer, David B., Hagen, John, Bakar, Adnan, and Grammatikopoulos, Kalliopi

Subjects
Pediatrics -- Patient outcomes, Heart -- Surgery, Acute renal failure -- Risk factors -- Demographic aspects -- Patient outcomes, Blood pressure -- Measurement, Health
Abstract

Background Blood pressure variability (BPV), defined as the degree of variation between discrete blood pressure readings, is associated with poor outcomes in acute care settings. Acute kidney injury (AKI) is a common and serious postoperative complication of cardiac surgery with cardiopulmonary bypass (CPB) in children. No studies have yet assessed the association between intraoperative BPV during cardiac surgery with CPB and the development of AKI in children. Methods A retrospective chart review of children undergoing cardiac surgery with CPB was performed. Intraoperative BPV was calculated using average real variability (ARV) and standard deviation (SD). Multiple regression models were used to examine the association between BPV and outcomes of AKI, hospital and intensive care unit (PICU) length of stay, and length of mechanical ventilation. Results Among 231 patients (58% males, median age 8.6 months) reviewed, 51.5% developed AKI (47.9% Stage I, 41.2% Stage II, 10.9% Stage III). In adjusted models, systolic and diastolic ARV were associated with development of any stage AKI (OR 1.40, 95% CI 1.08-1.8 and OR 1.4, 95% CI 1.05-1.8, respectively). Greater diastolic SD was associated with longer PICU length of stay ([beta] 0.94, 95% CI 0.62-1.2). When stratified by age, greater systolic ARV and SD were associated with AKI in infants [less than or equal to] 12 months, but there was no relationship in children > 12 months. Conclusions Greater BPV during cardiac surgery with CPB was associated with development of postoperative AKI in infants, suggesting that BPV is a potentially modifiable risk factor for AKI in this high-risk population. Graphical abstract, Author(s): Jennifer E. Fishbein [sup.1] , Matthew Barone [sup.2] , James B. Schneider [sup.3] , David B. Meyer [sup.4] , John Hagen [sup.5] , Adnan Bakar [sup.3] , Kalliopi Grammatikopoulos [...]

Published
2022
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7. Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: A contemporary multicenter analysis

Author

Mastropietro, Christopher W., Amula, Venu, Sassalos, Peter, Buckley, Jason R., Smerling, Arthur J., Iliopoulos, Ilias, Riley, Christine M., Jennings, Aimee, Cashen, Katherine, Narasimhulu, Sukumar Suguna, Narayana Gowda, Keshava Murty, Bakar, Adnan M., Wilhelm, Michael, Badheka, Aditya, Moser, Elizabeth A.S., and Costello, John M.

Published
2019
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13. Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?

Author

Gradidge, Eleanor A., Bakar, Adnan, Tellez, David, Ruppe, Michael, Tallent, Sarah, Bird, Geoffrey, Lavin, Natasha, Lee, Anthony, Adu-Darko, Michelle, Bain, Jesse, Biagas, Katherine, Branca, Aline, Breuer, Ryan K., Brown, Calvin, III, Bysani, G. Kris, Cheifitz, Ira M., Emeriaud, Guillaume, Gangadharan, Sandeep, Giuliano, John S., Jr, Howell, Joy D., Krawiec, Conrad, Lee, Jan Hau, Li, Simon, Meyer, Keith, Miksa, Michael, Napolitano, Natalie, Nett, Sholeen, Nuthall, Gabrielle, Orioles, Alberto, Owen, Erin B., Parker, Margaret M., Parsons, Simon, Polikoff, Lee A., Rehder, Kyle, Saito, Osamu, Sanders, Ronald C., Jr, Shenoi, Asha N., Simon, Dennis W., Skippen, Peter W., Tarquinio, Keiko, Thompson, Anne, Toedt-Pingel, Iris, Vanderford, Paula, Walson, Karen, Nadkarni, Vinay, and Nishisaki, Akira

Published
2018
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21. Acute Myopericarditis after COVID-19 Vaccine in Teenagers

Author

Ambati, Shashikanth, Colon, Michael, Mihic, Maya, Sanchez, Javier, and Bakar, Adnan

Subjects
Article Subject
Abstract

Background. There have been an increasing number of reports of myocarditis and pericarditis in adolescents and young adults after coronavirus disease 19 vaccinations. The pathophysiology of myocarditis after this vaccination is indeterminate currently. The problem is a relatively new phenomenon, and so there are no current guidelines on how to manage these cases of myopericarditis. We intend to describe our management in these two cases so that it can help guide pediatricians, intensivists, and cardiologists taking care of similar cases. Case Summaries. The first case is a young adolescent who presented with chest pain after receiving his second dose of coronavirus disease 19 vaccination with no other symptoms. His troponin was found to be 40 ng/mL. He had a normal echocardiogram and chest CT angiogram. His troponins trended down with symptomatic pain management after 3 days. The second case is another adolescent who presented with fever, fatigue, headache, and chest pain 3 days after receiving his second dose of coronavirus vaccine. His troponin was elevated to 5 ng/mL, electrocardiogram with ST segment elevations, and mildly decreased systolic function on echocardiogram. His troponins and electrocardiogram were normalized in 3 days at the time of his discharge. Conclusion. The clinical course of vaccine-associated myocarditis appears favorable as both our patients have responded well to medications and rest with prompt improvement in symptoms with full recovery. The experience remains limited at this time regarding the investigations, management, and follow-up of this novel clinical entity. It is vital for all the health care providers taking care of adolescents to have knowledge about this phenomenon and make correct diagnosis in those presenting with chest pain after COVID-19 vaccine and in preventing unnecessary invasive procedures such as coronary angiogram to rule out acute coronary syndromes.

Published
2021
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22. High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys.

Author

Harahsheh, Ashraf S., Kipps, Alaina K., Hart, Stephen A., Cassidy, Steven C., Clabby, Martha L., Hlavacek, Anthony M., Hoerst, Amanda K., Graupe, Margaret A., Madsen, Nicolas L., Bakar, Adnan M., Del Grippo, Erica L., Patel, Sonali S., Bost, James E., and Tanel, Ronn E.

Subjects
PEDIATRIC therapy, HOSPITAL surveys, CONTINUOUS positive airway pressure, CARDIOLOGY, SURGICAL clinics
Abstract

We utilized the multicenter Pediatric Acute Care Cardiology Collaborative (PAC3) 2017 and 2019 surveys to describe practice variation in therapy availability and changes over a 2-year period. A high acuity therapies (ATs) score was derived (1 point per positive response) from 44 survey questions and scores were compared to center surgical volume. Of 31 centers that completed the 2017 survey, 26 also completed the 2019 survey. Scores ranged from 11 to 34 in 2017 and 11 to 35 in 2019. AT scores in 2019 were not statistically different from 2017 scores (29/44, IQR 27–32.5 vs. 29.5/44, IQR 27–31, p = 0.9). In 2019, more centers reported initiation of continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) in Acute Care Cardiology Unit (ACCU) (19/26 vs. 4/26, p < 0.001) and permitting continuous CPAP/BiPAP (22/26 vs. 14/26, p = 0.034) compared to 2017. Scores in both survey years were significantly higher in the highest surgical volume group compared to the lowest, 33 ± 1.5 versus 25 ± 8.5, p = 0.046 and 32 ± 1.7 versus 23 ± 5.5, p = 0.009, respectively. Variation in therapy within the ACCUs participating in PAC3 presents an opportunity for shared learning across the collaborative. Experience with PAC3 was associated with increasing available respiratory therapies from 2017 to 2019. Whether AT scores impact the quality and outcomes of pediatric acute cardiac care will be the subject of further investigation using a comprehensive registry launched in early 2019. [ABSTRACT FROM AUTHOR]

Published
2021
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23. Contributors

Author

Abecassis, Isaac Josh, Abeysekera, Jayani, Adelson, P. David, Agbeko, Rachel S., Agus, Michael S.D., Ahmed, Mubbasheer, Akhondi-Asl, Alireza, Albert, Ben D., Alcamo, Alicia, Alder, Matthew N., Alibrahim, Omar, Allareddy, Veerajalandhar, Almodovar, Melvin C., Aminoff, Alexandra, Amlie-Lefond, Catherine, Aneja, Rajesh, Apple, Abigail, Argent, Andrew C., Arvedson, Joan C., Aspesberro, François, Atlas, Nir, Baatz, John E., Baden, Harris P., Bakar, Adnan M., Banker, Katherine, Barker, Piers C.A., Bass, Lee M., Basu, Rajit K., Bayir, Hülya, Becker, Lance B., Bell, Jamie L., Bell, Michael J., Bembea, Melania M., Bender, M.A., Benscoter, Alexis L., Benton, Wade W., Berg, Robert A., Berkman, Emily, Berkowitz, Carol, Biagas, Katherine V., Bishop, Naomi B., Blatt, Julie, Bodilly, Lauren, Bonow, Robert H., Bragg, E. Alexis, Brandom, Barbara W., Brilli, Richard J., Brogan, Thomas V., Bronicki, Ronald A., Browd, Samuel R., Bunchman, Timothy E., Burns, Jeffrey P., Butler, David F., Caglar, Derya, Camitta, Michael W., Campbell, M. Jay, Campbell, Sally, Capek, Karel D., Carboni, Michael P., Carcillo, Joseph A., Cassara, Antonio, Censoplano, Nina, Chadwick, Victoria, Chamberlain, Reid C., Chan, Anny, Charpie, John R., Cheifetz, Ira M., Chiwane, Saurabh, Chun, Robert H., Clark, Jeff, Clark, Jonna D., Clark, Robert S.B., Clawson, April, Clayton, Jason A., Conlon, Thomas, Conrad, Carol, Conway, Edward E., Jr, Coopersmith, Craig M., Corey, Seth J., Dahmer, Mary K., Dalton, Heidi J., Damania, Rahul C., Damian, Mihaela A., Dartois, Lauren, Davis, Peter J., Dervan, Leslie A., Deutschman, Clifford S., Dezfulian, Cameron, Dick, André A.S., Diekema, Douglas S., Dingeldein, Michael, Doctor, Allan, Downes, John J., Duncan, Christine, Edwards, Christopher M., Edwards, Lauren R., Egbuta, Chinyere, Eigen, Howard, Elfassy, Hannah Laure, Ellis, Alison M., Evans, Idris V.R., Farris, Reid W.D., Fineman, Jeffrey R., Fink, Ericka L., Fish, Frank A., Fitzgerald, Tamara N., Fleming, Gregory A., Flores, Saul, Flynn, Joseph T., Forbes, Michael L., Forbess, Joseph M., Franzon, Deborah E., Frazier, W. Joshua, Fuhrman, Bradley P., Ginther, Richard M., Jr, Glaser, Nicole, Graciano, Ana Lia, Gray, Megan M., Greathouse, Kristin C., Greenwald, Bruce M., Grinsell, Matthew M., Grunwell, Jocelyn R., Gunnarsson, Björn, Guzman, Marla, Hahn, Timothy, Hall, Mark W., Harding, Cary O., Hartman, Mary E., Hartmann, Silvia M., Havlin, Kevin M., Hayward, Kristen, Healey, Patrick J., Heard, Christopher M.B., Heneghan, Julia A., Herndon, David N., Hernan, Lynn J., Hill, Kevin D., Hoffman, Julien I., Holinski, Paula, Hong, Sue J., Horslen, Simon, Hoskote, Aparna, Hotz, Justin C., Ibsen, Laura Marie, Ijsselstijn, Hanneke, Jackson, Travis C., Jamal, Shelina M., Joshi, Prashant, Joyce, Emily L., Kallay, Tom, Kamat, Pradip P., Kane, Jason M., Kannankeril, Prince J., Karam, Oliver, Kenningham, Katherine L., Khalatbari, Hedieh, Khemani, Robinder G., Killien, Elizabeth Y., Kim, Yun, Kingsley, Jenny, Kirk, Christa Jefferis, Kirmani, Sonya, Kleinpell, Ruth, Kochanek, Patrick M., Kocis, Keith C., Kocoshis, Samuel A., Koves, Ildiko H., Kudchadkar, Sapna R., Kulik, Thomas J., Lacroix, Jacques, Lebet, Ruth, Lee, Amy, Lenker, Hallie, Levin, Daniel L., Levy, Emily R., Lewis-Newby, Mithya, Lin, John C., Maddux, Aline, Malone, Matthew P., Manole, Mioara, Marsh, Anne, Martin, Richard J., Mathur, Mudit, McArthur, Jennifer, McCusker, Christine, McDonald, Ruth A., Mehta, Nilesh M., Melvin, Ann J., Menon, Shina, Monagle, Paul, Morgan, Ryan W., Morgenstern, Peter F., Morowitz, Michael J., Morrison, Wynne, Munshi, Raj, Muszynski, Jennifer A., Nadkarni, Vinay M., Naiditch, Jessica A., Nakagawa, Thomas A., Nguyen, Vu, Nickless, Jenna R., Nishisaki, Akira, Norwood, Victoria F., Notterman, Daniel A., Oishi, Peter, Ojemann, Jeffrey, Olson, Michelle L., O’Neal, Jessie, Orloff, Kirsten, Otteson, Todd, Ouellette, Yves, Parakininkas, Daiva, Parker, Robert I., Peeler, Katherine Ratzen, Perez, Francisco A., Perry, Melvin G., Jr, Peters, Mark J., Pfeiffer, Brent J., Phelan, Rachel, Philip, Joseph, Pinto, Neethi, Pollack, Murray M., Preston, Thomas J., Prodhan, Parthak, Quang, Lawrence, Quasney, Michael W., Raffay, Thomas M., Rajapreyar, Prakadeshwari, Rakes, Lauren, Ramos-Jimenez, Rafael G., Ray, Samiran, Reed, Christopher R., Reese, James J., Jr, Rehder, Kyle J., Remy, Kenneth E., Reyes, Jorge D., Rhee, Eileen, Richardson, Clare, Roberts, Joan S., Guerineau, Luciana Rodriguez, Rogers, Stephen, Rotta, Alexandre T., Rowin, Mark E., Ruppel, Randall, Ryan, Rita M., Said, Ahmed, Sallee, Colin J., Sandler, Britt Julia, Sankar, Jhuma, Sarnaik, Ajit A., Sarnaik, Ashok P., Sawin, Robert, Schenkman, Kenneth A., Schexnayder, Stephen M., Schleien, Charles L., Schwartz, Stephanie P., Schwartz, Steven M., Shah, Jay, Shah, Sareen, Shaw, Dennis W.W., Shein, Steven L., Shoykhet, Michael, Simon, Dennis W., Sivarajan, V. Ben, Slain, Katherine N., Smith, Jodi M., Smith, Lincoln S., Sochet, Anthony A., Sorce, Lauren R., Sousse, Linda E., Spaeder, Michael C., Speicher, Richard H., Spinella, Philip C., Stalets, Erika L., Standage, Stephen Wade, Stark, Rebecca, Starr, Michelle C., Steinhorn, David M., Stenmark, Kurt R., Stewart, Claire A., Stollings, Lindsay M., Stulce, Casey, Su, Erik, Summers, Corinne, Sutton, Robert M., Symons, Jordan M., Sznycer-Taub, Nathaniel R., Tamburro, Robert T., Jr, Tapking, Christian, Tasker, Robert C., Tatum, Gregory H., Tilton, Ann H., Timlin, Matthew R., Tissieres, Pierre, Tobias, Joseph D., Toltzis, Philip, Topjian, Alexis A., Torgerson, Troy, Traube, Chani, Tucci, Marisa, Tuggle, David, Turi, Jennifer L., Turner, David A., Cleave, Alisa Van, van der Velden, Meredith G., Vogel, Adam M., Vohwinkel, Christine, Andre-von Arnim, Amelie von Saint, Vora, Surabhi B., Waghmare, Alpana, Wainwright, Mark S., Wallisch, Jessica S., Watson, R. Scott, Watt, Kevin, Weimer, Maria, Weiss, Scott L., Wenger, Jesse, Wheeler, Derek S., Wieczorek, Beth, Wilhelm, Michael, Wong, Hector R., Woods, Charles R., Jr, Woodward, George A. (Tony), Yang, Amy C., Yu, Heidi, Zane, Nicole R., Zerr, Danielle M., Zhang, Hui, Zheng, Hengqi (Betty), Zimmerman, Jerry J., Zimmerman, Kanecia, Zinter, Matt S., and Zuppa, Athena F.

Published
2022
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25. Multicenter Analysis of Truncal Valve Management and Outcomes in Children with Truncus Arteriosus.

Author

Bakar, Adnan M., Costello, John M., Sassalos, Peter, Amula, Venu, Buckley, Jason R., Smerling, Arthur J., Iliopoulos, Ilias, Riley, Christine M., Jennings, Aimee, Cashen, Katherine, Suguna Narasimhulu, Sukumar, Narayana Gowda, Keshava Murthy, Wilhelm, Michael, Badheka, Aditya, Slaven, James E., and Mastropietro, Christopher W.

Subjects
*VALVES, *CONGENITAL heart disease, *COMPETING risks
Abstract

Truncal valve management in patients with truncus arteriosus is a clinical challenge, and indications for truncal valve intervention have not been defined. We sought to evaluate truncal valve dysfunction and primary valve intervention in patients with truncus arteriosus and determine risk factors for later truncal valve intervention. We conducted a retrospective cohort study of children who underwent truncus arteriosus repair at 15 centers between 2009 and 2016. Multivariable competing risk analysis was performed to determine risk factors for later truncal valve intervention. We reviewed 252 patients. Forty-two patients (17%) underwent truncal valve intervention during their initial surgery. Postoperative extracorporeal support, CPR, and operative mortality for patients who underwent truncal valve interventions were statistically similar to the rest of the cohort. Truncal valve interventions were performed in 5 of 64 patients with mild insufficiency; 5 of 16 patients with mild-to-moderate insufficiency; 17 of 35 patients with moderate insufficiency; 5 of 9 patients with moderate-to-severe insufficiency; and all 10 patients with severe insufficiency. Twenty patients (8%) underwent later truncal valve intervention, five of whom had no truncal valve intervention during initial surgical repair. Multivariable analysis revealed truncal valve intervention during initial repair (HR 11.5; 95% CI 2.5, 53.2) and moderate or greater truncal insufficiency prior to initial repair (HR 4.0; 95% CI 1.1, 14.5) to be independently associated with later truncal valve intervention. In conclusion, in a multicenter cohort of children with truncus arteriosus, 17% had truncal valve intervention during initial surgical repair. For patients in whom variable truncal valve insufficiency is present and primary intervention was not performed, late interventions were uncommon. Conservative surgical approach to truncal valve management may be justifiable. [ABSTRACT FROM AUTHOR]

Published
2020
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27. Multicenter Analysis of Early Childhood Outcomes After Repair of Truncus Arteriosus.

Author

Buckley, Jason R., Amula, Venu, Sassalos, Peter, Costello, John M., Smerling, Arthur J., Iliopoulos, lias, Jennings, Aimee, Riley, Christine M., Cashen, Katherine, Suguna Narasimhulu, Sukumar, Gowda, Keshava Murthy Narayana, Bakar, Adnan M., Wilhelm, Michael, Badheka, Aditya, Moser, Elizabeth A.S., and Mastropietro, Christopher W.

Abstract

Background Literature describing morbidity and mortality after truncus arteriosus repair is predominated by single-center reports. We created and analyzed a multicenter dataset to identify risk factors for late mortality and right ventricle-to-pulmonary artery (RV-PA) conduit reintervention for this patient population. Methods We retrospectively collected data on children who underwent repair of truncus arteriosus without concomitant arch obstruction at 15 centers between 2009 and 2016. Cox regression survival analysis was conducted to determine risk factors for late mortality, defined as death occurring after hospital discharge and greater than 30 days after operation. Probability of any RV-PA conduit reintervention was analyzed over time using Fine-Gray modeling. Results We reviewed 216 patients with median follow-up of 2.9 years (range, 0.1 to 8.8). Operative mortality occurred in 15 patients (7%). Of the 201 survivors there were 14 (7%) late deaths. DiGeorge syndrome (hazard ratio [HR], 5.4; 95% confidence interval [CI], 1.6 to 17.8) and need for postoperative tracheostomy (HR, 5.9; 95% CI, 1.8 to 19.4) were identified as independent risk factors for late mortality. At least one RV-PA conduit catheterization or surgical reintervention was performed in 109 patients (median time to reintervention, 23 months; range, 0.3 to 93). Risk factors for reintervention included use of pulmonary or aortic homografts versus Contegra (Medtronic, Inc, Minneapolis, MN) bovine jugular vein conduits (HR, 1.9; 95% CI, 1.2 to 3.1) and smaller conduit size (HR per mm/m2, 1.05; 95% CI, 1.03 to 1.08). Conclusions In a multicenter dataset DiGeorge syndrome and need for tracheostomy postoperatively were found to be independent risk factors for late mortality after repair of truncus arteriosus, whereas risk of conduit reintervention was independently influenced by both initial conduit type and size. Visual Abstract [ABSTRACT FROM AUTHOR]

Published
2019
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31. Contributors

Author

Abecassis, Isaac Josh, Agbeko, Rachel S., Adelson, P. David, Alder, Matthew N., Al Ibrahim, Omar, Almodovar, Melvin C., Aminoff, Alexandra R., Amlie-LeFond, Catherine, Angus, Derek C., Arvedson, Joan C., Aspesberro, Francois, Baatz, John E., Baden, Harris P., Badugu, Srinivasarao, Bakar, Adnan M., Banker, Katherine, Bass, John L., Bayir, Hülya, Beaulieu, Pierre, Becker, Lance B., Bell, Michael J., Bender, M.A., Benton, Wade W., Berg, Robert A., Biagas, Katherine V., Bishop, Naomi B., Blatt, Julie, Blowey, Douglas L., Blumer, Jeffrey L., Bonow, Robert H., Brandom, Barbara W., Brilli, Richard J., Brogan, Thomas V., Bronicki, Ronald A., Browd, Samuel R., Bunchman, Timothy E., Burns, Jeffrey P., Caglar, Derya, Campbell, Sally, Carcillo, Joseph A., Carrillo-Lopez, Hector, Cashen, Katherine, Cassara, Antonio, Charpie, John R., Chavez, Adrian, Chun, Robert H., Clark, Jonna Derbenwick, Clark, Robert S.B., Clement, Katherine C., Conlon, Thomas, Conway, Edward E., Jr., Coopersmith, Craig M., Corey, Seth J., Cox, Peter N., Curley, Martha A.Q., Czosnyka, Marek, Dalton, Heidi J., Damian, Mihaela, Davis, Peter J., de Prost, Nicolas, Deutschman, Clifford S., Dezfulian, Cameron, Diekema, Douglas S., Doctor, Allan, Doherty, Meaghan, Dorfman, Molly V., Downes, John J., Dreyfuss, Didier, Duncan, Christine, Dupree, Phylicia D., Eigen, Howard, El-Hassan, Nahed, Eriksson, Carl O., Felmet, Kate, Fineman, Jeffrey R., Fink, Ericka L., Fish, Frank A., Fitzgerald, Tamara N., Flynn, Joseph T., Pérez Fontán, J. Julio, Forbes, Michael J., Forbess, Joseph M., Franzon, Deborah E., Frazier, W. Joshua, Fricker, F. Jay, Fuhrman, Bradley P., Garcia-Casal, Xiomara, Gardner, Rebecca, Gilad, Eli, Ginther, Richard M., Jr., Glaser, Nicole, Goodman, Denise M., Graciano, Ana Lía, Greathouse, Kristin C., Greenwald, Bruce M., Gunnarsson, Björn, Gupta, Punkaj, Hall, Mark W., Han, Yong Y., Harding, Cary O., Hartman, Mary E., Hartmann, Silvia M., Heard, Christopher M.B., Hernan, Lynn J., Heulitt, Mark J., Hoffman, Julien I., Horslen, Simon, Hunyady, Agnes I., Ibsen, Laura Marie, IJsselstijn, Hanneke, Inglis, Andrew, Jr., Irby, Gretchen A. Linggi, Irby, Olivia K., Ishak, Gisele E., Jackson, Travis C., Jacob, Susan, Jamal, Shelina M., Jardine, David, Jarillo, Alberto, Jeziorski, Alison M., Joashi, Umesh, Joshi, Prashant, Kagan, Richard J., Kannankeril, Prince J., Kanter, Robert K., Karam, Oliver, Kaspar, Cristin D.W., Khemani, Robinder G., King, Mary A., Kirk, Christa C. Jefferis, Kissoon, Niranjan (Tex), Kochanek, Patrick M., Kocis, Keith C., Kocoshis, Samuel A., Koh, Tsingyi, Kong, Ada, Koves, Ildiko H., Kulik, Thomas J., Kumar, Vasanth H., Lacroix, Jacques, Lakshminrusimha, Satyan, Lee, Thomas J., Leiner, Marie, Levin, Daniel L., Lewis-Newby, Mithya, Lieh-Lai, Mary W., Litalien, Catherine, Lopez-Magallon, Alejandro, Lynch, Robert, Lyons, John D., Maiyegun, Sitratullah, Makley, Amy T., Maldonado, Alfredo, Markovitz, Barry, Mazur, Paula M., McArthur, Jennifer, McLaughlin, Gwenn E., McLean, Susan F., Mehta, Nilesh M., Mehta, Renuka, Melvin, Ann J., Mian, Ayesa N., Mittal, Rohit, Moloney-Harmon, Patricia A., Monagle, Paul, Moorthy, Chet, Morrison, Wynne, Munoz, Ricardo, Munshi, Raj, Murthy, Srinivas, Muszynski, Jennifer A., Nadkarni, Vinay M., Nakagawa, Thomas A., Naran, Navyn, Neumayr, Tara M., Nishisaki, Akira, Norwood, Victoria F., Notterman, Daniel A., Nugent, Alan W., Oishi, Peter, Ojemann, Jeffrey, Orr, Richard A., Ouellette, Yves, Parakininkas, Daiva, Parker, Robert I., Pasala, Sanjiv, Pearson-Shaver, Tony, Peinado, Jesus, Peters, Mark J., Pfeiffer, Brent J., Phillipi, Carrie A., Pinsk, Maury N., Pollack, Murray M., Pon, Steven, Preston, Tom, Rajapreyar, Prakad, Ray, Samiran, Reade, Erin P., Remy, Kenneth E., Rhee, Eileen, Ricard, Jean-Damien, Richardson, Nicole L., Roberts, Joan S., Rogers, Stephen, Roth, Kimberly R., Rotta, Alexandre T., Rowin, Mark E., Rubin, Lewis P., Ruppel, Randall, Ryan, Rita M., Said, Ahmed, Sainte-Thomas, Nagela, Salonia, Rosanne, Sambalingam, Devaraj, Nelson Sanchez-Pinto, L., Sandquist, Mary, Sarnaik, Ajit A., Sarnaik, Ashok P., Saumon, Georges, Sawin, Robert, Scanlon, Matthew C., Schenkman, Kenneth A., Schexnayder, Stephen M., Schleien, Charles L., Schwartz, George J., Schwartz, Steven M., Schwenk, Hayden T., Seibel, Gabrielle Douthitt, Shaw, Dennis W.W., Shein, Steven L., Shepard, Charles W., Shoykhet, Michael, Simon, Dennis W., Sivarajan, V. Ben, Skippen, Peter, Smith, Lincoln S., Spaeder, Michael C., Speicher, Richard H., Spinella, Philip C., Standage, Stephen, Steinhorn, David M., Stewart, Claire, Storm, Elizabeth A., Stroud, Michael H., Su, Erik, Sutton, Robert M., Symons, Jordan M., Talano, Julie-An, Tamburro, Robert T., Jr., Tasker, Robert C., Thompson, Ann E., Tilton, Ann H., Tobias, Joseph D., Todres, I. David, Torgerson, Troy, Traube, Chani, Tucci, Marisa, Turner, David A., Tyroch, Alan H., Cleave, Alisa Van, van der Velden, Meredith G., Vaughan, David J., Vazquez, Erika, Venkataraman, Shekhar T., Visoiu, Mihaela, von Saint André-von Arnim, Amélie, Vora, Surabhi B., Waghmare, Alpana, Wainwright, Mark S., Wakeham, Martin, Wallace, Carol A., Wallisch, Jessica S., Watson, R. Scott, Webb, Ashley N., Weiss, Scott L., Wenger, Jesse, Wheeler, Derek S., Wilson, Harry, Wong, Hector R., Wood, Ellen Glenn, Woolf, Alan D., Yaghmai, Beryl F., Yanay, Ofer, Zerr, Danielle M., Zheng, Hengqi (Betty), and Zimmerman, Jerry J.

Published
2017
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32. Isoflurane Protects Against Human Endothelial Cell Apoptosis by Inducing Sphingosine Kinase-1 via ERK MAPK.

Author

Bakar, Adnan M., Park, Sang Won, Kim, Mihwa, and Lee, H. Thomas

Subjects
*ISOFLURANE, *SPHINGOSINE kinase, *APOPTOSIS, *MITOGEN-activated protein kinases, *ENDOTHELIUM, *CRITICAL care medicine, *ANESTHETICS
Abstract

Endothelial dysfunction is a major clinical problem affecting virtually every patient requiring critical care. Volatile anesthetics are frequently used during the perioperative period and protect the heart and kidney against ischemia and reperfusion injury. We aimed to determine whether isoflurane, the most commonly used volatile anesthetic in the USA, protects against endothelial apoptosis and necrosis and the mechanisms involved in this protection. Human endothelial EA.hy926 cells were pretreated with isoflurane or carrier gas (95% room air + 5% CO2) then subjected to apoptosis with tumor necrosis factor-α or to necrosis with hydrogen peroxide. DNA laddering and in situ Terminal Deoxynucleotidyl Transferase Biotin-dUTP Nick-End Labeling (TUNEL) staining determined EA.hy926 cell apoptosis and percent LDH released determined necrosis. We also determined whether isoflurane modulates the expression and activity of sphingosine kinase-1 (SK1) and induces the phosphorylation of extracellular signal regulated kinase (ERK MAPK) as both enzymes are known to protect against cell death. Isoflurane pretreatment significantly decreased apoptosis in EA.hy926 cells as evidenced by reduced TUNEL staining and DNA laddering without affecting necrosis. Mechanistically, isoflurane induces the phosphorylation of ERK MAPK and increased SK1 expression and activity in EA.hy926 cells. Finally, selective blockade of SK1 (with SKI-II) or S1P1 receptor (with W146) abolished the anti-apoptotic effects of isoflurane. Taken together, we demonstrate that isoflurane, in addition to its potent analgesic and anesthetic properties, protects against endothelial apoptosis most likely via SK1 and ERK MAPK activation. Our findings have significant clinical implication for protection of endothelial cells during the perioperative period and patients requiring critical care. [ABSTRACT FROM AUTHOR]

Published
2012
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33. A pilot study to evaluate self initiated computer patient education in children with acute asthma in pediatric emergency department.

Author

Joshi, Ashish, Lichenstein, Richard, Rafei, Keyvan, Bakar, Adnan, and Arora, Mohit

Subjects
ASTHMA in children, PEDIATRIC emergencies, PEDIATRIC emergency services, CHILD health services, HEALTH education, EMERGENCY medical services
Abstract

Objective: The goal of the study was to investigate the feasibility and acceptance of an interactive computer assisted asthma education program in the pediatric emergency department (ED) for children with acute asthma exacerbations. Methods: A pre-post non- randomized study was designed for children age 3 to 18 years at the University of Maryland Hospital for Children, Baltimore. An interactive computer-assisted educational program, Patient Education and Motivation Tool (PEMT), was designed using learning theories, to teach children about asthma and its management. Sixty nine children were enrolled during an ED visit for acute asthma between May 2006 and November 2006. Socio-demographic and asthma knowledge information was gathered using questionnaires. An attitudinal survey was used to assess the acceptance of the program. Results: Eighty one percent (n=56) of the children found PEMT very easy to use, and seventy five percent (n=52) agreed to use it in near future. There was a significant thirteen percent improvement in knowledge of asthma after the completion of this computer assisted asthma education program (p=0.01). Conclusion: PEMT is highly acceptable and is an effective way to provide asthma education in an ED setting. [ABSTRACT FROM AUTHOR]

Published
2007
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34. Contributors

Author

Ackerman, Veda L., Adelson, P. David, Agbeko, Rachel S., Almodovar, Melvin C., Alonso, Estella M., Aneja, Raj K., Angus, Derek C., Argent, Andrew C., Aspesberro, Francois P., Bakar, Adnan M., Bambach, Barbara, Bass, Lee M., Bayir, Hülya, Beaulieu, Pierre, Bell, Michael J., Bender, M.A., Benson, Jeffrey C., Benton, Wade W., Berg, Robert A., Berkowitz, Darryl H., Bhutta, Omar J., Biagas, Katherine C., Blatt, Julie, Blowey, Douglas L., Blumer, Jeffrey L., Bradley, John S, Brandom, Barbara W., Brodsky, Linda, Brogan, Thomas V., Brothers, Adam W., Bunchman, Timothy E., Burd, Randall S., Burns, Jeffrey, Bush, Sean P., Bystrak, Louis L., Campbell, Angela J.P., Cannavino, Christopher R., Carcillo, Joseph A., Carrillo-Lopez, Hector, Cassara, Antonio, Caty, Michael G., Charpie, John R., Chavez, Adrian, Christenson, John C., Clark, Jonna D., Clark, Robert S.B., Clement, Katherine C., Coalson, Jacqueline J., Coopersmith, Craig M., Coppola, Christopher P., Corey, Seth J., Cox, Peter N., Cummings, James J., Curley, Martha A.Q., Czosnyka, Marek, D’Angelis, Christopher A., Dahmer, Mary K., Dalton, Heidi J., Davis, Peter J., Morena, M. Theresa de la, Oliveira, Cláudio Flauzino de, Dhanani, Sonny, Dobyns, Emily L., Donner, Elizabeth J., Doughty, Lesley, Dreyfuss, Didier, Duncan, Christine, Durand, Philippe, Duthie, Susan, Eigen, Howard, Maamoun El-Dawy, Waleed M., Elliott, Steven, Emery, Helen M., Escobar, Mauricio A., Jr., Evans, Jacqueline M., Felmet, Kate, Fineman, Jeffrey R., Fink, Ericka L., Fiser, Richard T., Fish, Frank A., Fletcher, James E., Forbes, Michael J., Fort, Amber E., Fost, Norman, Frader, Joel E., Franzon, Deborah E., Fricker, F. Jay, Friess, Stuart, Fuhrman, Bradley P., Garcia-Casal, Xiomara, Gauvin, France, Gaynor, J. William, Gilad, Eli, Gilbert, James C., Glaser, Nicole S., Goldstein, Stuart L., Goodman, Denise M., Graciano, Ana Lía, Gunnarsson, Björn, Hahn, Cecil D., Hall, Mark, Hamilton, Melinda Fiedor, Han, Yong Y., Hanson, Cherissa, Harding, Cary O., Hartman, Mary E., Hazelzet, Jan A., Heard, Christopher M.B., Heine, Ann Marie, Hernan, Lynn J., Hertzig, Jeremy S., Heulitt, Mark J., Hoffman, Julien I.E., Huhta, James C., Ichord, Rebecca, Inglis, Andrew, Linggi Irby, Gretchen A., Jacobs, Brian, Jardine, David, Jarillo-Quijada, Alberto, Javouey, Etienne, Jefferis Kirk, Christa C., Johns, James A., Joshi, Prashant, Kagan, Richard J., Kannankeril, Prince J., Kanter, Robert K., Karam, Oliver, Kasten, Kevin R., Kelly, Michael, Khanna, Paritosh C., Kochanek, Patrick M., Kocis, Keith C., Kocoshis, Samuel A., Koves, Ildiko H., Kulik, Thomas J., Kumar, Vasanth H., Lacroix, Jacques, Lakshminrusimha, Satyan, Langley, Joanne M., Laussen, Peter C., Levin, Daniel L., Lewis-Newby, Mithya, Lieh-Lai, Mary W., Lindsey, Daphne, Litalien, Catherine, Lynch, Robert E., Makley, Amy T., Marcin, James P., Mariscalco, Mary Michele, Markovitz, Barry, Martin, Lynn D., Maxvold, Norma J., Mazur, Paula M., McArthur, Jennifer A., McLaughlin, Jerry, McLaughlin, Gwenn E., Redwine, Karen McNiece, Mehta, Nilesh M., Mehta, Renuka, Melvin, Ann J., Menon, Sharad, Mian, Ayesa N., Michelson, Kelly, Michienzi, Kelly A., Moloney-Harmon, Patricia A., Monagle, Paul, Moss, Michele M., Mou, Steven S., Muenzer, Jared T., Nadkarni, Vinay, Nakagawa, Thomas A., Naran, Navyn, Nguyen, Trung, Nicholson, Carol E., Nielsen, Katie R., Northway, Tracie, Norwood, Victoria F., Notterman, Daniel A., Nowak, Jeffrey E., Oishi, Peter, Orr, Richard A., Ouellette, Yves, Parakininkas, Daiva, Parker, Margaret M., Pearson-Shaver, Tony, Pérez Fontán, J. Julio, Peters, Mark, Pihoker, Catherine, Pinsk, Maury N., Pollack, Murray M., Pon, Steven, Quasney, Michael, Rajasekaran, Surender, Rampersad, Sally E., Ranjit, Suchitra, Reade, Erin P., Reese Jr., James J., Relvas, Monica, Remy, Kenneth E., Ricard, Jean-Damien, Rice, Tom B., Ridling, Debra Ann, Roberts, Joan S., Ross, Ashley S., Roth, Kimberly R., Rotta, Alexandre T., Rowin, Mark E., Roy, John, Rubino, Christopher M., Ruppel, Randall A., Rushton, Cynda H., Ryan, Rita M., Salonia, Rosanne, Salvin, Joshua, Sanders Jr., Ronald C., Sarnaik, Ajit A., Sarnaik, Ashok P., Saumon, Georges, Sawin, Robert, Scanlon, Matthew C., Schenkman, Kenneth A., Schexnayder, Stephen M., Schleien, Charles L., Schwartz, George J., Schwartz, Steven M., Shann, Frank, Shaw, Dennis W.W., Shemie, Sam D., Shoykhet, Mish, Sivarajan, V. Ben, Skippen, Peter W., Slonim, Anthony D., Smith, Laurie, Smith, Lincoln S., Standage, Stephen W., Steinberg, Joel B., Steinhorn, David M., Stojanovski, Sasko D., Storm, Elizabeth A., Stroud, Michael H., Sturgill, Marc G., Sutton, Robert M., Symons, Jordan M., Tailounie, Muayyad, Talano, Julie-An, Tamburro Jr., Robert, Tasker, Robert C., Thompson, Ann E., Tilton, Ann H., Tinmouth, Alan, Tobias, Joseph D., Tobin, Nicole H., Todres, I. David, Tucci, Marisa, Ulate, Kalia P., Valentine, Kevin M., Vaughan, David J., Venkataraman, Shekhar T., Visoiu, Mihaela, von Saint André–von Arnim, Amélie, Wainwright, Mark S., Wakeham, Martin K., Watson, R. Scott, Webb, Ashley N., Weigle, Carl, Weimer, Maria B., Wessel, David L., Wetzel, Randall C., Wong, Hector R., Wood, Ellen G., Woolf, Alan D., Woytash, James J., Yanay, Ofer, Zaritsky, Arno, Zerr, Danielle M., and Zimmerman, Jerry J.

Published
2011
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36. Abstract 13306: The Pediatric Acute Care Cardiology Collaborative (PAC3) Hospital Acute Care Unit Survey: Results and Implications.

Author

Hoerst, Amanda, Bakar, Adnan, Cassidy, Steven, Clabby, Martha, Del Grippo, Erica, Graupe, Margaret, Harahsheh, Ashraf, Hlavacek, Anthony M, Hart, Stephen A, Kipps, Alaina K, Madsen, Nicolas, O'Neil, Dora D, Patel, Sonali S, Strohacker, Courtney M, and Tanel, Ronn E

Subjects
*PEDIATRIC intensive care, *CARDIAC intensive care, *HOSPITAL care, *NURSE-patient ratio, *CORONARY care units, *INTENSIVE care units, *HOSPITAL surveys
Abstract

Introduction: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to understand systems and clinical practices in cardiac care delivered outside the intensive care unit with a focus on outcomes, quality improvement, and patient safety. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. Methods: The survey consisted of 126 stem questions. Many questions had branching logic for positive responses leading to 412 total possible response fields. Questions were categorized into domains: demographics, staffing, resources and therapies, and standard care practices. Five supplemental questions addressed patient and surgical volume variables. Responses were recorded and stored in a REDCap database. Results: Surveys were completed by 31 (91%) of 34 member centers. A majority (19, 61%) of centers have a single, dedicated cardiac acute care unit (ACU), which is contiguous or on the same floor as the ICU in 15 (48%). A nurse staffing ratio of 3:1 is employed in 71% of centers and 26 (84%) reported having a resource nurse. Centralized wireless rhythm monitoring is used in 26 (84%) centers with 14 (54%) staffed continuously. Table 1 shows the use of various high-acuity therapies. Figure 1 illustrates the varied use of protocols and procedures in this population. Conclusions: The PAC3 hospital survey is the most thorough effort to understand systems and clinical care practices in the cardiac ACU to date. It demonstrates notable heterogeneity and varied practice patterns amongst units. Further study may identify a combination of structure and services that can enhance efficiency, safety, and patient outcomes. [ABSTRACT FROM AUTHOR]

Published
2018

37. Hemodynamic Impact of Oxygen Desaturation During Tracheal Intubation Among Critically Ill Children With Cyanotic and Noncyanotic Heart Disease.

Author

Mokhateb-Rafii, Tanya, Bakar, Adnan, Gangadharan, Sandeep, Gradidge, Eleanor A, Tellez, David, Ruppe, Michael, Tallent, Sarah, Bird, Geoffrey, Lavin, Natasha, Lee, Anthony, Napolitano, Natalie, Nadkarni, Vinay, Shults, Justine, Nishisaki, Akira, and National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Published
2018
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38. Downward Trend in Pediatric Resident Laryngoscopy Participation in PICUs.

Author

Gabrani, Aayush, Kojima, Taiki, Sanders, Ronald C., Shenoi, Asha, Montgomery, Vicki, Parsons, Simon J., Gangadharan, Sandeep, Nett, Sholeen, Napolitano, Natalie, Tarquinio, Keiko, Simon, Dennis W., Lee, Anthony, Emeriaud, Guillaume, Adu-Darko, Michelle, Giuliano, John S., Meyer, Keith, Graciano, Ana Lia, Turner, David A., Krawiec, Conrad, and Bakar, Adnan M.

Published
2018
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40. New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection.

Author

Ambati S, Mihic M, Rosario DC, Sanchez J, and Bakar A

Abstract

There has been a worldwide increase in cases of diabetic ketoacidosis in both adults and children with diabetes during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This can be multifactorial: delayed care due to reduced medical services, fear of approaching hospitals, or SARS-CoV-2 infection itself. It is well-known that infection is an important trigger for diabetic ketoacidosis in children with type 1 or type 2 diabetes mellitus, but little is known whether SARS-CoV-2 infection can trigger diabetic ketoacidosis and new-onset diabetes mellitus in a child with no previous history of diabetes mellitus. The association of SARS-CoV-2 as a trigger for new-onset diabetes requires further investigation, as the incidence of diabetes is steadily rising in the pediatric population during the pandemic. This case report explores two cases where children present in diabetic ketoacidosis with concurrent SARS-CoV-2 infection and no known history of type 1 diabetes mellitus., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ambati et al.)

Published
2022
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41. Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis.

Author

Riley CM, Mastropietro CW, Sassalos P, Buckley JR, Costello JM, Iliopoulos I, Jennings A, Cashen K, Suguna Narasimhulu S, Gowda KMN, Smerling AJ, Wilhelm M, Badheka A, Bakar A, Moser EAS, and Amula V

Subjects
Administration, Inhalation, Female, Humans, Infant, Newborn, Male, Nitric Oxide adverse effects, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Truncus Arteriosus, Persistent diagnostic imaging, Truncus Arteriosus, Persistent physiopathology, United States, Vasodilator Agents adverse effects, Cardiac Surgical Procedures adverse effects, Nitric Oxide administration & dosage, Postoperative Care trends, Practice Patterns, Physicians' trends, Pulmonary Circulation drug effects, Truncus Arteriosus, Persistent surgery, Vascular Resistance drug effects, Vasodilator Agents administration & dosage
Abstract

Background: Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR., Objectives: We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period., Design: Retrospective cohort study., Setting: 15 tertiary care pediatric referral centers., Patients: All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016., Interventions: Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use., Main Results: We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p = .02) were independently associated with iNO use., Conclusions: In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy., (© 2019 Wiley Periodicals, Inc.)

Published
2019
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42. Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC 3 ) hospital survey.

Author

Hoerst A, Bakar A, Cassidy SC, Clabby M, Grippo ED, Graupe M, Harahsheh AS, Hlavacek AM, Hart SA, Kipps AK, Madsen NL, O'Neil DD, Patel SS, Strohacker CM, and Tanel RE

Subjects
Cardiologists trends, Cardiovascular Agents therapeutic use, Health Care Surveys, Heart-Assist Devices trends, Humans, Noninvasive Ventilation trends, Nursing Staff, Hospital trends, Pediatricians trends, Personnel Staffing and Scheduling trends, United States, Wireless Technology trends, Cardiology trends, Cardiology Service, Hospital trends, Healthcare Disparities trends, Pediatrics trends, Practice Patterns, Physicians' trends, Quality Improvement trends, Quality Indicators, Health Care trends
Abstract

Background: The Pediatric Acute Care Cardiology Collaborative (PAC 3 ) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC 3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions., Methods: A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap)., Results: Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients., Conclusions: The PAC 3 hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients., (© 2019 Wiley Periodicals, Inc.)

Published
2019
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