High-Risk Committee for Cardiac Surgery Decision-Making: Results From 110 Consecutive Patients

Huckaby, Lauren V.; Gleason, Thomas G.; Ferdinand, Francis D.; Sultan, Ibrahim; Chu, Danny; Yoon, Pyongsoo; Navid, Forozan; Venkata, Siva P; West, David B.; Lima, Claudio A.B.; Morell, Victor O.; Chen, Shangzhen; Thoma, Floyd; Drew, Sasha; Kilic, Arman

doi:10.1016/j.athoracsur.2020.09.014

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…An ECMO Council can be implemented across a variety of ECMO centers and can be easily tailored to individual programs. The ECMO Council parallels other multidisciplinary care teams for specific indications, such as submassive and massive pulmonary embolism, 23 high-risk cardiac surgery, 24 and solid organ transplantation.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

et al. 2022

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Coronavirus disease 2019 (COVID-19) has increased the demand for extracorporeal membrane oxygenation (ECMO) and introduced distinct challenges to patient selection for ECMO. Standardized processes for patient selection amidst resource limitations are lacking, and data on ECMO consults are underreported. We retrospectively reviewed consecutive adult ECMO consults for acute respiratory failure received at a single academic medical center from April 1, 2020, to February 28, 2021, and evaluated the implementation of a multidisciplinary selection committee (ECMO Council) and standardized framework for patient selection for ECMO. During the 334-day period, there were 202 total ECMO consults; 174 (86.1%) included a diagnosis of COVID-19. Among all consults, 157 (77.7%) were declined and 41 (20.3%) resulted in the initiation of ECMO. Frequent reasons for decline included the presence of multiple relative contraindications (n = 33), age greater than 60 years (n = 32), and resource limitations (n = 27). The ECMO Council deliberated on every case in which an absolute contraindication was not present (n = 96) via an electronic teleconference platform. Utilizing multidisciplinary consensus together with a standardized process for patient selection in ECMO is feasible during a pandemic and may be reliably exercised over time. Whether such an approach is feasible at other centers remains unknown.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

et al. 2022

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Transparency, Public Reporting, and a Culture of Change to Quality and Safety in Cardiac Surgery

Ibrahim

Szeto

Gutsche

et al. 2022

The Annals of Thoracic Surgery

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Balancing quality and quaternary care imperative using a high-risk case review committee in adults

Ibrahim

Acker

Weiss

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives Quaternary care centers have an imperative to serve as hospitals of last resort and must also meet professional quality targets. We developed a high-risk review committee (HRC) to evaluate cases meeting pre-defined predicted risk cut-offs as a part of an overall quality improvement drive. Methods We describe the structure, outcomes and effects of the Penn high risk committee (HRC). Using propensity-matching, we investigated whether the committee modifies or screens risk. We used multivariable analysis to examine impact of unmeasured variables on clinical outcomes in this cohort. Results Institutional predicted and observed mortality had already been in decline prior to HRC institution in 2017, due to a multi-facetted quality improvement initiative. Between 2017–2020, the HRC discussed 205 patients with a median predicted risk of mortality of 10.6% (range 0.4–66%). CABG was the most commonly presented operation. 155 patients underwent operation (risk 10.3%), 12 had surgery deferred for optimization (risk 6%), 50 had surgery declined (risk 11.7%) and 12 patients had a deferred decision for further investigation. Overall 30-day survival was 86% for the entire cohort and 89% for operated patients. A matched analysis of similar patients prior to and following the HRC showed that the HRC did not directly modify outcomes. Most patients had better than expected survival (observed: expected mortality < 1). Predicted risk did not predict 30 day mortality among this high risk cohort. Conclusions HRCs serve as an important element in quality-improvement by encouraging a thoughtful approach and channeling the collective experience of a group of senior surgeons. It may improve patient selection by identifying a cohort with extremely poor survival, while allowing safe operation with acceptable outcomes among a group with very high operative risk.

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High-Risk Committee for Cardiac Surgery Decision-Making: Results From 110 Consecutive Patients

Cited by 3 publications

References 13 publications

Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

Transparency, Public Reporting, and a Culture of Change to Quality and Safety in Cardiac Surgery

Balancing quality and quaternary care imperative using a high-risk case review committee in adults

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