Variation in Implementation and Outcomes of Early Extubation Practices After Infant Cardiac Surgery

The origins and development of the Cardiac Neurodevelopmental Outcome Collaborative: creating innovative clinical, quality improvement, and research opportunities

“…With the growth of quality improvement registries, transparent collaboration alone can lead to improved outcomes and the ability to conduct trials within a registry may also be feasible. [41][42][43][44][45][46][47] We anticipate that the Cardiac Neurodevelopmental Outcome Collaborative will benefit its member institutions by improving neurodevelopmental and psychosocial outcomes at the lowest cost, maximising patient and family experience, and facilitating a fully integrated service network of allied professionals including medical, mental health, education, and habilitative service providers. The Neurodevelopmental Core Lab, in collaboration with the Education and Training Committee, will continue to develop the initial work of the School Age and Infant/Toddler Working groups with the goal of developing and refining approaches to evaluation and management within member institutions.…”

Enhancing efficiency and scientific impact of a clinical trials network: the Pediatric Heart Network Integrated CARdiac Data and Outcomes (iCARD) Collaborative

“…The projects have focused on two major areas: (1) promoting research efficiency and optimizing PHN study design, and (2) supporting research not possible with PHN study datasets alone. [11][12][13][14][15][16] Two major areas focused in the projects are promoting research efficiency and optimising PHN study design, and supporting research not possible with PHN study data sets alone. These investigations, which are detailed further in the sections below, have spanned the areas of health economics, outcomes research, quality improvement, and implementation science, augmenting the traditional clinical trials focus of the PHN.…”

“…11 In an additional analysis, investigators integrated qualitative data from a semi-structured survey with the main study data set to better understand variability in how sites approached implementation of the clinical practice guideline and their outcomes. 12 They found the site with sustained outcomes employed several unique strategies regarding implementation of the intervention during the study period, including involvement of additional key local staff, regular in-person data reviews to review progress and overcome any challenges in a timely manner, additional data collection when needed to address staff concerns, and creation of supplemental care protocols to support local implementation of the core clinical practice guideline. These data are important in informing better design of future initiatives to promote sustainability.…”

“…These data are important in informing better design of future initiatives to promote sustainability. 12 Finally, a third study which also integrated data from the main study with the PC 4 Registry is in progress and studying spillover to other patient populations aside from the population included in the initial study. This series of investigations highlights the value of integration of PHN study data with these other data sources in offering an efficient and more comprehensive understanding of the impact of the intervention studied beyond the knowledge gained from the main study.…”

Commentary: False start—Offense: Premature data may cost more than five yards

“…Multiple such processes already exist within the congenital cardiac surgery field (and within the wider sphere of cardiothoracic surgery) by virtue of center and provider participation in national quality-collaboratives. [2][3][4] The concept and structural framework for ERAS programs in other surgical disciplines, including cardiac surgery, have been described previously. [5][6][7][8][9] Typical components include preoperative optimization of nutritional and functional status (smoking and excessive alcohol cessation), use of alternative analgesics (acetaminophen, gabapentin) to reduce opioid use, aggressive use of antiemetics, early feeding, pulmonary recruitment, and early mobilization.…”