Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program
Introduction: Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the...
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| Veröffentlicht in: | Telemedicine journal and e-health 2018-07, Vol.24 (7), p.489-496 |
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| creator | Lopez-Magallon, Alejandro J. Saenz, Lucas Lara Gutierrez, Jorge Florez, Claudia X. Althouse, Andrew D. Sharma, Mahesh S. Duran, Alvaro Salazar, Leonardo Munoz, Ricardo |
| description | Introduction:
Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the delivery of quality interventions.
Materials and Methods:
This is a retrospective review of pediatric patients assisted with ECMO in the cardiac intensive care unit (CICU) at Fundación Cardiovascular de Colombia from July 2011 to June 2015 (telemedicine) compared with similar patients from a previous period (pretelemedicine). Collected information included demographic data, cardiac diagnosis, risk adjustment for congenital heart surgery (RACHS-1), hospital mortality, CICU and hospital length of stay (LOS), ECMO type, and ECMO run hours as well as specific telemedicine information.
Results:
Fifty-seven patients in the pretelemedicine and 109 in the telemedicine periods were included in the analysis. Forty-nine teleconsulted patients received 218 teleconsultations, with a recommendation for diagnostic or interventional catheterization in 38 patients (77.5%). A surgical procedure for significant residual lesions was recommended in 30 patients (61.2%). Patients in the telemedicine period were older (4.7 months vs. 1.6 months,
p
= 0.006), more likely to receive operating room ECMO (43.1% vs. 24.6%,
p
= 0.02), and had a higher proportion of patients with two-ventricle physiology (73.4% vs. 54.4%,
p
= 0.013). Hospital survival was higher during the telemedicine period (54.1% vs. 29.8%,
p
= 0.002), with a longer hospital LOS (67 days vs. 28 days,
p
< 0.001).
Conclusion:
The implementation of telemedicine-assisted interventions in a pediatric ECMO program delivered valuable diagnostic and therapeutic advice, was associated with significant changes in selection criteria and model of care, and an increased hospital survival. |
| doi_str_mv | 10.1089/tmj.2017.0223 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1978720832</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1978720832</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-add8a54397ce0c5530c545e7230f5836aa507a83a39b5f5648221d20e5e5f7db3</originalsourceid><addsrcrecordid>eNqFkLtPwzAQhy0EglIYWZFHlhQ_6jhhqyoelYpaQZmji3OpjPIojovowt-OoxZWJp9P3_109xFyxdmIsyS99fX7SDCuR0wIeUQGXKk4knGcHve1ZJGKhT4j5133zhgbcy1OyZlIhRKcpwPyvcIKayyssQ1S29BlqME7a-jUWW8NVHQKDu_ohL6gd223QePtJ9JXvy12_QQ0dNZ4dA142zaBv__yDkzrNq3D8H3GOncQ0hdfuzXuKbp07dpBfUFOSqg6vDy8Q_L2cL-aPkXzxeNsOplHRkrtIyiKBNRYptogMyqcZdRYoRaSlSqRMYBiGhIJMs1VqeJxIgQvBEOFqtRFLofkZp-7ce3HFjuf1bYzWFVhr3bbZTzViRYskSKg0R414djOYZltnK3B7TLOsl55FpRnvfKsVx7460P0Ng8i_-hfxwGQe6BvQ9NUFnN0_p_YH9zaj0w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1978720832</pqid></control><display><type>article</type><title>Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program</title><source>Alma/SFX Local Collection</source><creator>Lopez-Magallon, Alejandro J. ; Saenz, Lucas ; Lara Gutierrez, Jorge ; Florez, Claudia X. ; Althouse, Andrew D. ; Sharma, Mahesh S. ; Duran, Alvaro ; Salazar, Leonardo ; Munoz, Ricardo</creator><creatorcontrib>Lopez-Magallon, Alejandro J. ; Saenz, Lucas ; Lara Gutierrez, Jorge ; Florez, Claudia X. ; Althouse, Andrew D. ; Sharma, Mahesh S. ; Duran, Alvaro ; Salazar, Leonardo ; Munoz, Ricardo</creatorcontrib><description>Introduction:
Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the delivery of quality interventions.
Materials and Methods:
This is a retrospective review of pediatric patients assisted with ECMO in the cardiac intensive care unit (CICU) at Fundación Cardiovascular de Colombia from July 2011 to June 2015 (telemedicine) compared with similar patients from a previous period (pretelemedicine). Collected information included demographic data, cardiac diagnosis, risk adjustment for congenital heart surgery (RACHS-1), hospital mortality, CICU and hospital length of stay (LOS), ECMO type, and ECMO run hours as well as specific telemedicine information.
Results:
Fifty-seven patients in the pretelemedicine and 109 in the telemedicine periods were included in the analysis. Forty-nine teleconsulted patients received 218 teleconsultations, with a recommendation for diagnostic or interventional catheterization in 38 patients (77.5%). A surgical procedure for significant residual lesions was recommended in 30 patients (61.2%). Patients in the telemedicine period were older (4.7 months vs. 1.6 months,
p
= 0.006), more likely to receive operating room ECMO (43.1% vs. 24.6%,
p
= 0.02), and had a higher proportion of patients with two-ventricle physiology (73.4% vs. 54.4%,
p
= 0.013). Hospital survival was higher during the telemedicine period (54.1% vs. 29.8%,
p
= 0.002), with a longer hospital LOS (67 days vs. 28 days,
p
< 0.001).
Conclusion:
The implementation of telemedicine-assisted interventions in a pediatric ECMO program delivered valuable diagnostic and therapeutic advice, was associated with significant changes in selection criteria and model of care, and an increased hospital survival.</description><identifier>ISSN: 1530-5627</identifier><identifier>EISSN: 1556-3669</identifier><identifier>DOI: 10.1089/tmj.2017.0223</identifier><identifier>PMID: 29252119</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Original Research</subject><ispartof>Telemedicine journal and e-health, 2018-07, Vol.24 (7), p.489-496</ispartof><rights>2018, Mary Ann Liebert, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-add8a54397ce0c5530c545e7230f5836aa507a83a39b5f5648221d20e5e5f7db3</citedby><cites>FETCH-LOGICAL-c337t-add8a54397ce0c5530c545e7230f5836aa507a83a39b5f5648221d20e5e5f7db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29252119$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopez-Magallon, Alejandro J.</creatorcontrib><creatorcontrib>Saenz, Lucas</creatorcontrib><creatorcontrib>Lara Gutierrez, Jorge</creatorcontrib><creatorcontrib>Florez, Claudia X.</creatorcontrib><creatorcontrib>Althouse, Andrew D.</creatorcontrib><creatorcontrib>Sharma, Mahesh S.</creatorcontrib><creatorcontrib>Duran, Alvaro</creatorcontrib><creatorcontrib>Salazar, Leonardo</creatorcontrib><creatorcontrib>Munoz, Ricardo</creatorcontrib><title>Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program</title><title>Telemedicine journal and e-health</title><addtitle>Telemed J E Health</addtitle><description>Introduction:
Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the delivery of quality interventions.
Materials and Methods:
This is a retrospective review of pediatric patients assisted with ECMO in the cardiac intensive care unit (CICU) at Fundación Cardiovascular de Colombia from July 2011 to June 2015 (telemedicine) compared with similar patients from a previous period (pretelemedicine). Collected information included demographic data, cardiac diagnosis, risk adjustment for congenital heart surgery (RACHS-1), hospital mortality, CICU and hospital length of stay (LOS), ECMO type, and ECMO run hours as well as specific telemedicine information.
Results:
Fifty-seven patients in the pretelemedicine and 109 in the telemedicine periods were included in the analysis. Forty-nine teleconsulted patients received 218 teleconsultations, with a recommendation for diagnostic or interventional catheterization in 38 patients (77.5%). A surgical procedure for significant residual lesions was recommended in 30 patients (61.2%). Patients in the telemedicine period were older (4.7 months vs. 1.6 months,
p
= 0.006), more likely to receive operating room ECMO (43.1% vs. 24.6%,
p
= 0.02), and had a higher proportion of patients with two-ventricle physiology (73.4% vs. 54.4%,
p
= 0.013). Hospital survival was higher during the telemedicine period (54.1% vs. 29.8%,
p
= 0.002), with a longer hospital LOS (67 days vs. 28 days,
p
< 0.001).
Conclusion:
The implementation of telemedicine-assisted interventions in a pediatric ECMO program delivered valuable diagnostic and therapeutic advice, was associated with significant changes in selection criteria and model of care, and an increased hospital survival.</description><subject>Original Research</subject><issn>1530-5627</issn><issn>1556-3669</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkLtPwzAQhy0EglIYWZFHlhQ_6jhhqyoelYpaQZmji3OpjPIojovowt-OoxZWJp9P3_109xFyxdmIsyS99fX7SDCuR0wIeUQGXKk4knGcHve1ZJGKhT4j5133zhgbcy1OyZlIhRKcpwPyvcIKayyssQ1S29BlqME7a-jUWW8NVHQKDu_ohL6gd223QePtJ9JXvy12_QQ0dNZ4dA142zaBv__yDkzrNq3D8H3GOncQ0hdfuzXuKbp07dpBfUFOSqg6vDy8Q_L2cL-aPkXzxeNsOplHRkrtIyiKBNRYptogMyqcZdRYoRaSlSqRMYBiGhIJMs1VqeJxIgQvBEOFqtRFLofkZp-7ce3HFjuf1bYzWFVhr3bbZTzViRYskSKg0R414djOYZltnK3B7TLOsl55FpRnvfKsVx7460P0Ng8i_-hfxwGQe6BvQ9NUFnN0_p_YH9zaj0w</recordid><startdate>20180701</startdate><enddate>20180701</enddate><creator>Lopez-Magallon, Alejandro J.</creator><creator>Saenz, Lucas</creator><creator>Lara Gutierrez, Jorge</creator><creator>Florez, Claudia X.</creator><creator>Althouse, Andrew D.</creator><creator>Sharma, Mahesh S.</creator><creator>Duran, Alvaro</creator><creator>Salazar, Leonardo</creator><creator>Munoz, Ricardo</creator><general>Mary Ann Liebert, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180701</creationdate><title>Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program</title><author>Lopez-Magallon, Alejandro J. ; Saenz, Lucas ; Lara Gutierrez, Jorge ; Florez, Claudia X. ; Althouse, Andrew D. ; Sharma, Mahesh S. ; Duran, Alvaro ; Salazar, Leonardo ; Munoz, Ricardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-add8a54397ce0c5530c545e7230f5836aa507a83a39b5f5648221d20e5e5f7db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Original Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopez-Magallon, Alejandro J.</creatorcontrib><creatorcontrib>Saenz, Lucas</creatorcontrib><creatorcontrib>Lara Gutierrez, Jorge</creatorcontrib><creatorcontrib>Florez, Claudia X.</creatorcontrib><creatorcontrib>Althouse, Andrew D.</creatorcontrib><creatorcontrib>Sharma, Mahesh S.</creatorcontrib><creatorcontrib>Duran, Alvaro</creatorcontrib><creatorcontrib>Salazar, Leonardo</creatorcontrib><creatorcontrib>Munoz, Ricardo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Telemedicine journal and e-health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopez-Magallon, Alejandro J.</au><au>Saenz, Lucas</au><au>Lara Gutierrez, Jorge</au><au>Florez, Claudia X.</au><au>Althouse, Andrew D.</au><au>Sharma, Mahesh S.</au><au>Duran, Alvaro</au><au>Salazar, Leonardo</au><au>Munoz, Ricardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program</atitle><jtitle>Telemedicine journal and e-health</jtitle><addtitle>Telemed J E Health</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>24</volume><issue>7</issue><spage>489</spage><epage>496</epage><pages>489-496</pages><issn>1530-5627</issn><eissn>1556-3669</eissn><abstract>Introduction:
Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the delivery of quality interventions.
Materials and Methods:
This is a retrospective review of pediatric patients assisted with ECMO in the cardiac intensive care unit (CICU) at Fundación Cardiovascular de Colombia from July 2011 to June 2015 (telemedicine) compared with similar patients from a previous period (pretelemedicine). Collected information included demographic data, cardiac diagnosis, risk adjustment for congenital heart surgery (RACHS-1), hospital mortality, CICU and hospital length of stay (LOS), ECMO type, and ECMO run hours as well as specific telemedicine information.
Results:
Fifty-seven patients in the pretelemedicine and 109 in the telemedicine periods were included in the analysis. Forty-nine teleconsulted patients received 218 teleconsultations, with a recommendation for diagnostic or interventional catheterization in 38 patients (77.5%). A surgical procedure for significant residual lesions was recommended in 30 patients (61.2%). Patients in the telemedicine period were older (4.7 months vs. 1.6 months,
p
= 0.006), more likely to receive operating room ECMO (43.1% vs. 24.6%,
p
= 0.02), and had a higher proportion of patients with two-ventricle physiology (73.4% vs. 54.4%,
p
= 0.013). Hospital survival was higher during the telemedicine period (54.1% vs. 29.8%,
p
= 0.002), with a longer hospital LOS (67 days vs. 28 days,
p
< 0.001).
Conclusion:
The implementation of telemedicine-assisted interventions in a pediatric ECMO program delivered valuable diagnostic and therapeutic advice, was associated with significant changes in selection criteria and model of care, and an increased hospital survival.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>29252119</pmid><doi>10.1089/tmj.2017.0223</doi><tpages>8</tpages></addata></record> |
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| source | Alma/SFX Local Collection |
| subjects | Original Research |
| title | Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program |
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