Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...

The CDH study group collected patient data from 2015 to 2018 in a retrospective review of prospectively collected data examining cardiac dysfunction within the first 48 hours of life.

Among all CDH patients in the study period, 39% had some evidence of cardiac dysfunction on their first echocardiogram in the first 48 hours of life.

Patients with normal cardiac function had a survival of over 80% on adjusted analysis.

Patients with right ventricular dysfunction only had a survival of 74%.

Patients with left ventricular dysfunction had a survival of 57%.

Patients with biventricular dysfunction had a survival of 50%, the worst risk profile.

Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality in CDH.

The standardized post-operative protocol for Nuss pectus repair included scheduled anti-emetics, epidural pain control discontinued on post-op day 2, early Foley removal, and encouraged ambulation.

The standardized protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days.

There were zero readmissions out of 164 patients in the Nuss pectus repair standardization study.

The Cincinnati Children's pectus protocol did not use cryotherapy for pain control in any patients.

The Cincinnati authors acknowledged studies showing cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy, yet expressed reservations due to lack of long-term outcomes data.