Table 1.
Demographic, Clinical, and Surgical Details and Outcomes of Included Patients
| Variable | Total (n=502) | Center 1 (n=213) | Center 2 (n=40) | Center 3 (n=98) | Center 4 (n=56) | Center 5 (n=95) | P Value |
|---|---|---|---|---|---|---|---|
| Years included, range | 2011–2018 | 2010–2018 | 2009–2018 | 2009–2016 | 2011–2016 | 2011–2016 | … |
| Age (d), median (IQR) | 5 (3–6) | 4 (3–6) | 6 (5–8) | 4 (3–6) | 4 (3–6) | 5 (3–7) | <0.001 |
| Gestational age (wk), median (IQR) | 39 (38–39) | 38 (37–39) | 39 (38–39) | 39 (38–39) | 39 (38–39) | 39 (38–39) | <0.001 |
| Prematurity*, n (%) | 38 (8) | 18 (8) | 1 (3) | 7 (7) | 3 (5) | 9 (8) | 0.624 |
| Weight (kg), median (IQR) | 3.2 (2.9–3.5) | 3.2 (2.9–3.5) | 3.1 (2.8–3.4) | 3.2 (2.8–3.5) | 3.3 (3.0–3.6) | 3.2 (2.8–3.5) | 0.700 |
| Sex (male), n (%) | 330 (66) | 150 (70) | 26 (65) | 65 (66) | 34 (61) | 55 (58) | 0.256 |
| Cardiac diagnosis, n (%) | |||||||
| HLHS | 442 (88) | 173 (81) | 40 (100) | 98 (100) | 48 (86) | 83 (87) | |
| DILV/DIRV | 19 (4) | 12 (6) | 0 (0) | 0 (0) | 5 (9) | 2 (2) | |
| AV canal, unbalanced | 17 (4) | 13 (6) | 0 (0) | 0 (0) | 3 (5) | 1 (1) | <0.001† |
| DORV, hypo LV | 8 (2) | 3 (1) | 0 (0) | 0 (0) | 0 (0) | 5 (5) | |
| TA | 14 (3) | 10 (5) | 0 (0) | 0 (0) | 0 (0) | 4 (4) | |
| Other | 2 (0) | 2 (1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
| Surgical characteristics | |||||||
| Type of shunt, n (%) | |||||||
| Blalock‐Taussig shunt | 173 (34) | 46 (22) | 12 (30) | 27 (28) | 30 (54) | 58 (61) | <0.001 |
| Sano shunt | 329 (66) | 167 (78) | 28 (70) | 71 (72) | 26 (46) | 37 (39) | |
| CPB time, min | 166 (140–206) | 176 (142–217) | 181 (142–198) | 164 (147–210) | 85 (79–93) | 185 (162–212) | <0.001 |
| DHCA time, min | 10 (4–26) | 11 (5–25) | 2 (0–4) | 5 (3–9) | 45 (40–49) | 9 (8–13) | <0.001 |
| Aortic clamp time, min | 78 (60–105) | 94 (72–128) | 58 (52–70) | 67 (61–75) | 45 (40–49) | 98 (87–113) | <0.001 |
| ECMO support | |||||||
| ECMO support within 28 d, n (%) | 50 (10) | 29 (14) | 6 (15) | 7 (7) | 1 (2) | 6 (6) | 0.027 |
| Failure to wean from CPB, n (%) | 23 (5) | 12 (6) | 6 (15) | 1 (1) | 0 (0) | 4 (4) | <0.001† |
| Time from surgery to ECMO (d), median (IQR) | 1 (0–9) | 1 (0–8) | 0 (0–0) | 2 (1–10) | 26 | 0 (0–15) | 0.116 |
| ECMO duration (d), median (IQR) | 5 (3–10) | 6 (2–13) | 5 (3–12) | 3 (2–9) | 4 | 4 (3–8) | 0.699 |
| Mandatory ventilation | |||||||
| Length of mandatory ventilation (d), median (IQR) | 8 (5–16) | 12 (8–21) | 12 (8–21) | 6 (4–13) | 3 (2–4) | 6 (5–12) | <0.001 |
| Minimum ventilation rate per day (breaths/min), median (IQR)‡ | 14 (11–17) | 14 (12–18) | 20 (18–26) | 14 (12–16) | 10 (8–10) | 12 (0–14) | <0.001 |
| Opioid use | |||||||
| Firstline opioid infusion, n (%) | |||||||
| Fentanyl | 334 (66) | 140 (66) | 14 (35) | 32 (33) | 56 (100) | 92 (97) | <0.001 |
| Morphine | 168 (34) | 73 (34) | 26 (65) | 66 (67) | 0 (0) | 3 (3) | |
| Length of opioid administration (d), n (%) | 13 (8–25) | 15 (10–27) | 16 (9–27) | 15 (7–24) | 6 (3–10) | 12 (8–26) | <0.001 |
| Opioid TDD (morphine equivalents, mg/kg per d), median (IQR)‡ | 0.57 (0.16–1.65) | 0.79 (0.26–2.1) | 1.17 (0.48–2.41) | 0.42 (0.13–1.59) | 0.15 (0.06–0.73) | 0.34 (0.16–1.14) | <0.001 |
| Fluid management | |||||||
| Daily intake (mL/kg per d), median (IQR)‡ | 136 (124–152) | 135 (121–147) | 144 (131–159) | 147 (134–157) | 130 (118–151) | 132 (111–156) | <0.001 |
| Daily output (mL/kg per d), median (IQR)‡ | 108 (94–122) | 112 (102–131) | 117 (108–128) | 108 (97–120) | 59 (75–53) | 100 (91–122) | <0.001 |
| Daily fluid balance (mL/kg per d), median (IQR)‡ | 25 (15–39) | 18 (7–26) | 25 (19–34) | 35 (25–41) | 71 (48–86) | 26 (18–39) | <0.001 |
| Patients' outcomes | |||||||
| CICU length of stay (d), median (IQR) | 16 (10–28) | 17 (11–30) | 35 (22–56)§ | 9 (7–16) | 11 (9–16) | 23 (16–31) | <0.001 |
| Hospital length of stay (d), median (IQR) | 34 (23–56) | 35 (24–70) | 35 (22–56) | 30 (20–44) | 22 (17–31) | 51 (35–109) | <0.001 |
| Survival at 30 d, n (%) | 473 (94) | 199 (93) | 36 (90) | 92 (94) | 52 (93) | 94 (99) | 0.225 |
| Survival at discharge, n (%) | 444 (88) | 187 (88) | 34 (85) | 89 (91) | 51 (91) | 83 (87) | 0.813 |
Missing data, n: age, 13; gestational age, 92; CBP, DHCA, aortic clamp times: 1; CICU and hospital length of stay, 4. AV indicates atrioventricular; CICU, cardiac intensive care unit; CPB, cardiopulmonary bypass; DHCA, deep hypothermic cardiac arrest; DILV, double inlet left ventricle; DIRV, double inlet right ventricle; DORV, double outlet right ventricle; ECMO, extracorporeal membrane oxygenation; HLHS, hypoplastic left heart syndrome; IQR, interquartile range; LV, left ventricle; TA, tricuspid atresia; and TDD, total daily dose.
Prematurity is defined as <37 weeks estimated gestational age.
Fisher exact test. Bonferroni‐corrected pairwise comparisons are reported in Table S1.
Values are medians (IQR) of median ventilation rate per day per patient.
ICU and hospital length of stay identical at Center 2 because of a center‐specific care model dictating location of care.