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Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane
Alejandro J Lopez-Magallon1, Lucas Saenz1, Jorge Lara Gutierrez1
11 Division of Cardiac Intensive Care, Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania.
Insights
Telemedicine significantly improved survival rates in pediatric extracorporeal membrane oxygenation (ECMO) patients by providing expert guidance. This approach enhanced care delivery and optimized outcomes for critically ill children requiring ECMO support.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Medical Technology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital intervention for pediatric cardiopulmonary collapse.
- Expertise in ECMO management is limited, posing challenges for optimal patient outcomes.
- Telemedicine offers a potential solution to enhance the quality of ECMO interventions.
Purpose of the Study:
- To evaluate the impact of telemedicine on pediatric extracorporeal membrane oxygenation (ECMO) programs.
- To compare outcomes of pediatric ECMO patients before and after telemedicine implementation.
- To assess the role of telemedicine in improving diagnostic and therapeutic interventions.
Main Methods:
- Retrospective review of pediatric ECMO patients from July 2011 to June 2015.
- Comparison of a pre-telemedicine period with a telemedicine-assisted period.
- Analysis of demographic data, cardiac diagnosis, mortality, length of stay, and ECMO parameters.
Main Results:
- Hospital survival was significantly higher in the telemedicine period (54.1% vs. 29.8%, p=0.002).
- Telemedicine was associated with older patient age and increased use of operating room ECMO.
- Teleconsultations led to recommendations for catheterization and surgical procedures in a high percentage of cases.
Conclusions:
- Telemedicine-assisted interventions in pediatric ECMO programs provide valuable diagnostic and therapeutic advice.
- Implementation of telemedicine led to significant changes in patient selection and care models.
- Telemedicine is associated with improved hospital survival in pediatric ECMO patients.
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.
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