Transcatheter PDA Occlusion in VLBW Infants: Development of an Intraprocedural and Transportation Safety Protocol for Homeostasis
Presenter
Frank F. Ing, M.D., MSCAI, UC Davis Medical Center, Carmichael, CA
Frank F. Ing, M.D., MSCAI1, Andrew Pelech, M.D., FSCAI2, JoAnne Natale, MD3, Dua Anderson, MD3, Don Null, MD1 and Satyan Lakshminrusimha, MD3, (1)UC Davis Medical Center, Carmichael, CA, (2)Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (3)-, Carmichael, CA
Keywords: Complications, Occlusion Devices and Quality
Background
PDA occlusion in the VLBW infants is safe & effective but requires meticulous care to maintain homeostasis during transportation between the NICU and the cath lab for successful outcomes.
Methods
A prospective QI project monitored PDA occlusions in VLBW infants (5/2018-12/2019). A multi-disciplinary team (interventionist, neonatologist, anesthesiologist, cath lab staff & bedside nurse) was formed for pre- & post-procedure discussions. A transportation & intraprocedural protocol and checklist were developed to optimize temperature, glucose and ventilation homeostasis. Further refinements for the checklist & incremental process improvements were made after each case. Patient profile, cath lab data & early outcomes were analyzed.
Results:
30 VLBW infants (median BW: 714.5 gm; range:460-1120) underwent PDA occlusion. Median age & weight at time of procedure was 26.5 days (14-49) and 1080 gm (625-2000) respectively. Successful occlusion was achieved in 29 (96.7%). In 1 pt, the device embolized into the LPA and was retrieved without incident. Preventable adverse events (13) and a checklist of preventive measures are listed in table 1. Twelve preventable adverse events (AEs) occurred among the first 19 pts, resulting in process improvements for subsequent cases. For the latter 11 cases, only 1 AEs occurred (RUL atelectasis).
Conclusions
Transcatheter PDA occlusion in VLBW infants can be performed successfully. While maintenance of homeostasis in this high-risk group is challenging, a vigilant multidisciplinary approach utilizing a standard protocol and checklist can mitigate AEs. Further studies to confirm efficacy and safety are warranted.
