91% Decrease in Mortality with Gastroschisis Bundle!

In Latin American countries, mortality from gastroschisis can exceed 15%

The study compared outcomes in the first 42 patients treated after protocol implementation to the last 42 patients treated before protocol adoption

Prior to the protocol, pre-transfer communication was incredibly limited

After protocol implementation, the accepting hospital was in much closer communication

Prior to the protocol, every patient got a central line

After the protocol, every patient had a PICC attempted

Prior to the protocol, all patients were taken to the operating room for primary reduction after extension of the defect, which was limited by OR availability and required general anesthesia

After the protocol, bedside reduction was attempted in most patients

Prior to the protocol, all patients were mechanically ventilated and paralyzed, and feeding advancement was totally at the discretion of the surgeon

After the protocol, only patients with respiratory distress were intubated

After the protocol, no patients were paralyzed

After the protocol, the authors followed a regimented feeding advancement schedule

The authors found a shorter time to arrival after protocol implementation

After protocol implementation, there was less general anesthesia use

After protocol implementation, fewer central lines were placed

After protocol implementation, fewer patients needed to be intubated

After protocol implementation, patients who were intubated spent less time on the ventilator

The mortality rate went from 22% to 2% after protocol implementation

The Hospital Infantil de Mexico team had a 22% mortality with gastroschisis before the protocol, which was higher than most

The five protocol changes resulted in a reduction from 22% mortality to 2% mortality

Moving from surgical central lines to PICC lines reduced mortality