M14 The Impact of Cardiopulmonary Bypass and Cross-Clamp Time on Patient Outcomes

Background:Creation of an extracardiac cavopulmonary connection has been proposed as a superior alternative to the lateral intracardiac tunnel for the completion of total cavopulmonary connection.Methods and results:We made a retrospective review of our experience with 125 patients undergoing a total cavopulmonary connection between June 1994 and January 2003. Our experience with the extracardiac connection for completion began in 1999. Since 1994, we have constructed an intracardiac tunnel in 50 patients, and an extracardiac connection in 75. Of the total number, 83 had undergone an earlier partial cavopulmonary connection. Additional intracardiac procedures were performed in 43 patients at time of completion, in 25 of those undergoing extracardiac completion, and in 18 of the patients having an intracardiac procedure. The mean size of the tube used for completion was 19 mm. The mean cross-clamp time for placement of the intracardiac tunnel was 77 min, with a median of 80.5 min, and a mean cardiopulmonary bypass time of 139 min, with a median of 131 min. For construction of the extracardiac connection, a mean cross-clamp time in 24 of the 75 patients was 54 min, with a median of 54 min. Mean cardiopulmonary bypass time for all the patients with an extracardiac connection was 100 min, with a median of 88 min. Reoperations were needed in 10 patients, 6 having intracardiac and 4 extracardiac procedures. Of these, 5 were early and 5 late, including one take down. None of the patients died after these interventions. Taken overall, 8 patients died, with 5 early deaths. In the multivariable analysis, cardiopulmonary bypass time of more than 120 min, atrioventricular valvar replacement, and banding of the pulmonary trunk prior to the total cavopulmonary connection, all reached statistical significance for early death, whereas only heterotaxy syndrome remained as the sole risk factor for late death. There was no significant difference in survival between the modifications used.Discussion:Whereas we could not identify any clinical superiority for the extracardiac approach in the short-term, the concept of extracardiac completion has helped to simplify the overall procedure. Longer follow-up will be required to elucidate any potential advantages.

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The Impact of Diabetes on Patient Outcomes After Ankle Fracture

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70403-6 ◽

2006 ◽

Vol 2006 ◽

pp. 102-103

Author(s):

M.F. Swiontkowski

Keyword(s):

Patient Outcomes ◽

Ankle Fracture ◽

The Impact

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Minimal access coronary revascularistaion without cardiopulmonary bypass- The impact of robotic technology in the current clinical practice

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1581/mrcas.2004.010106 ◽

2004 ◽

Vol 01 (01) ◽

pp. 98

Author(s):

Roberto Casula ◽

Thanes Athanasiou ◽

Ara Darzi

Keyword(s):

Clinical Practice ◽

Cardiopulmonary Bypass ◽

Current Clinical Practice ◽

Minimal Access ◽

Robotic Technology ◽

The Impact

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The Impact of Electronic Knowledge-Based Nursing Content and Decision-Support on Nursing-Sensitive Patient Outcomes

10.21236/ada614256 ◽

2014 ◽

Author(s):

Mary L. Hook

Keyword(s):

Decision Support ◽

Patient Outcomes ◽

Knowledge Based ◽

The Impact

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Diabetes Discharge Planning and Transitions of Care: A Focused Review

Current Diabetes Reviews ◽

10.2174/1573399814666180711120830 ◽

2019 ◽

Vol 15 (2) ◽

pp. 111-117 ◽

Cited By ~ 9

Author(s):

Robin L. Black ◽

Courtney Duval

Keyword(s):

Patient Outcomes ◽

Hospital Admissions ◽

Discharge Planning ◽

Medication Management ◽

Hospital Readmissions ◽

The United States ◽

Transitions Of Care ◽

Discharge Process ◽

The Impact ◽

Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

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Measuring frailty in younger populations: a rapid review of evidence

BMJ Open ◽

10.1136/bmjopen-2020-047051 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047051

Author(s):

Gemma F Spiers ◽

Tafadzwa Patience Kunonga ◽

Alex Hall ◽

Fiona Beyer ◽

Elisabeth Boulton ◽

...

Keyword(s):

Patient Outcomes ◽

Predictive Validity ◽

Data Extraction ◽

Grey Literature ◽

Frailty Index ◽

Study Data ◽

Rapid Review ◽

Eligibility Criteria ◽

Adult Age ◽

The Impact

ObjectivesFrailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care.DesignA rapid review of primary studies was conducted.Data sourcesFour databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020.Eligibility criteriaEligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English.Data extraction and synthesisRecords were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach.ResultsWe identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18–59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care.ConclusionsLimited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.

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The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Journal of Advanced Nursing ◽

10.1111/jan.14909 ◽

2021 ◽

Author(s):

Diane E. Twigg ◽

Lisa Whitehead ◽

Gemma Doleman ◽

Sonia El‐Zaemey

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Nurse Staffing ◽

The Impact

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The impact of exogenous nitric oxide during cardiopulmonary bypass for cardiac surgery

Perfusion ◽

10.1177/02676591211014821 ◽

2021 ◽

pp. 026765912110148

Author(s):

Joseph Mc Loughlin ◽

Lorraine Browne ◽

John Hinchion

Keyword(s):

Nitric Oxide ◽

Systematic Review ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Troponin I ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

High Quality Research ◽

Low Cardiac Output Syndrome ◽

The Impact

Objectives: Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis. Methods: A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered. Results: Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences. Conclusion: This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

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