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Article: Calcium Chloride Is Given to Sicker Patients During Cardiopulmonary Resuscitation Events.

Savorgnan, Fabio / Acosta, Sebastian

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2022 Volume 23, Issue 11, Page(s) 938–940

MeSH term(s)	Humans ; Calcium Chloride ; Cardiopulmonary Resuscitation ; Heart Arrest/therapy ; Resuscitation
Chemical Substances	Calcium Chloride (M4I0D6VV5M)
Language	English
Publishing date	2022-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000003051
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Zs.A 5600: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 472: Show issues

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Article: Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race.

Savorgnan, Fabio / Hassan, Adel / Borges, Nirica / Acosta, Sebastian

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2023 Volume 24, Issue 6, Page(s) 458–462

Abstract: Objectives: Pulse oximetry (Sp o2 ) may overestimate arterial oxygen saturation (Sa o2 ) in blood laboratory testing. This study aimed to assess Sp o2 -Sa o2 difference in relation to race (i.e., patient self-reporting as Black or White), occult ... ...

Abstract	Objectives: Pulse oximetry (Sp o2 ) may overestimate arterial oxygen saturation (Sa o2 ) in blood laboratory testing. This study aimed to assess Sp o2 -Sa o2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. Design: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Sp o2 and Sa o2 data according to approved comparisons. Occult hypoxemia was defined as Sp o2 greater than 92% and Sa o2 less than 88%. Setting: Quaternary pediatric hospital. Patients: Pediatric COVID-19 patients admitted to Texas Children's Hospital between May 2020 and December 2021. Interventions: None. Measurements and main results: There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients ( p < 0.001), and this bias increased as the oxygen saturations decreased ( p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively ( p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory). Conclusions: We found an oximetry bias in the measurement of Sp o2 with respect to Sa o2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.
MeSH term(s)	Humans ; Child ; Retrospective Studies ; Oxygen ; COVID-19 ; Oximetry/methods ; Hypoxia/diagnosis
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000003208
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Article ; Online: Cardiac Arrest With or Without Need for Extracorporeal Life Support After Congenital Cardiac Surgery.

Bencie, Nicole / Savorgnan, Fabio / Binsalamah, Ziyad / Resheidat, Ashraf / Vener, David F / Faraoni, David

The Annals of thoracic surgery

2023 Volume 117, Issue 4, Page(s) 813–819

Abstract: Background: Postoperative cardiac arrest (CA) with or without need for extracorporeal cardiopulmonary resuscitation (ECPR) is one of the most significant complications in the early postoperative period after pediatric cardiac operation. The objective of ...

Abstract	Background: Postoperative cardiac arrest (CA) with or without need for extracorporeal cardiopulmonary resuscitation (ECPR) is one of the most significant complications in the early postoperative period after pediatric cardiac operation. The objective of this study was to develop and to validate a predictive model of postoperative CA with or without ECPR. Methods: In this retrospective cohort study, we reviewed data from patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) between July 20, 2020, and December 31, 2021. Variables included demographic data, presence of preoperative risk factors, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality categories, perioperative data, residual lesion score (RLS), and vasoactive-inotropic score (VIS). We used multivariable logistic regression analysis to develop a predictive model. Results: The incidence of CA with or without ECPR was 4.4% (n = 24/544). Patients who experienced postoperative CA with or without ECPR were younger (age, 130 [54-816.5] days vs 626 [127.5-2497.5] days; P < .050) and required longer CPB (253 [154-332.5] minutes vs 130 [87-186] minutes; P < .010) and cross-clamp (116.5 [75.5-143.5] minutes vs 64 [30-111] minutes; P < .020) times; 37.5% of patients with an outcome had at least 1 preoperative risk factor (vs 16.9%; P < .010). Our multivariable logistic regression determined that the presence of at least 1 preoperative risk factor (P = .005), CPB duration (P = .003), intraoperative residual lesion score (P = .009), and postsurgery vasoactive-inotropic score (P = .010) were predictors of the incidence of CA with or without ECPR. Conclusions: We developed a predictive model of postoperative CA with or without ECPR after congenital cardiac operation. Our model performed better than the individual scores and risk factors.
MeSH term(s)	Child ; Humans ; Cardiac Surgical Procedures/adverse effects ; Cardiopulmonary Resuscitation/adverse effects ; Extracorporeal Membrane Oxygenation/adverse effects ; Heart Arrest/epidemiology ; Heart Arrest/etiology ; Heart Arrest/therapy ; Retrospective Studies ; Thoracic Surgery ; Infant ; Child, Preschool
Language	English
Publishing date	2023-09-12
Publishing country	Netherlands
Document type	Review ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.09.003
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Zs.A 252: Show issues

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Article ; Online: The use of neutrophil-lymphocyte ratio for the prediction of refractory disease and coronary artery lesions in patients with Kawasaki disease.

Farias, Juan S / Villarreal, Enrique G / Savorgnan, Fabio / Acosta, Sebastian / Flores, Saul / Loomba, Rohit S

Cardiology in the young

2023 Volume 33, Issue 8, Page(s) 1409–1417

Abstract: Background: Kawasaki disease is a vasculitis that can lead to cardiac complications, including coronary artery disease and cardiogenic shock. Various scoring systems have been developed to determine those that will be refractory to routine intravenous ... ...

Abstract	Background: Kawasaki disease is a vasculitis that can lead to cardiac complications, including coronary artery disease and cardiogenic shock. Various scoring systems have been developed to determine those that will be refractory to routine intravenous immunoglobulin therapy or develop coronary artery disease. The objective of this study was to determine if the neutrophil-lymphocyte ratio could predict refractory disease and coronary artery lesions in patients with Kawasaki disease. Methods: A systematic review of the literature was performed to identify manuscripts describing comparisons of neutrophil-lymphocyte ratio between those who had refractory disease and those who did not, and between those who developed coronary artery lesions and those who did not. Mean difference was compared between groups. Areas under the curve were utilised to determine the pooled area under the curve. Results: 12 studies with 5593 patients were included in the final analyses of neutrophil-lymphocyte ratio for the prediction of refractory disease. Neutrophil-lymphocyte ratio before therapy was higher in refractory disease with a mean difference of 2.55 (p < 0.01) and pooled area under the curve of 0.724. Neutrophil-lymphocyte ratio after therapy was higher in refractory disease with a mean difference of 1.42 (p < 0.01) and pooled area under the curve for of 0.803. Five studies with 1690 patients were included in the final analyses of neutrophil-lymphocyte ratio for the prediction of coronary artery lesions. Neutrophil-lymphocyte ratio before therapy was higher in coronary artery lesions with a mean difference of 0.65 (p < 0.01). Conclusion: The use of neutrophil-lymphocyte ratio may help physicians in the identification of patients at risk of refractory disease and coronary artery lesions in patients with Kawasaki disease.
MeSH term(s)	Humans ; Infant ; Coronary Artery Disease/etiology ; Coronary Artery Disease/complications ; Immunoglobulins, Intravenous/therapeutic use ; Lymphocytes ; Mucocutaneous Lymph Node Syndrome/complications ; Mucocutaneous Lymph Node Syndrome/diagnosis ; Mucocutaneous Lymph Node Syndrome/drug therapy ; Neutrophils ; Retrospective Studies
Chemical Substances	Immunoglobulins, Intravenous
Language	English
Publishing date	2023-04-04
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951123000653
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Zs.A 4050: Show issues

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Article ; Online: Markov model for detection of ECG instability prior to cardiac arrest in single-ventricle patients.

Savorgnan, Fabio / Crouthamel, Daniel I / Heroy, Andy / Santerre, John / Acosta, Sebastian

Journal of electrocardiology

2023 Volume 80, Page(s) 106–110

Abstract: Objectives: Assess the degree of instability in the electrocardiogram (ECG) waveform in patients with single-ventricle physiology before a cardiac arrest and compare them with similar patients who did not experience a cardiac arrest.: Methods: ... ...

Abstract	Objectives: Assess the degree of instability in the electrocardiogram (ECG) waveform in patients with single-ventricle physiology before a cardiac arrest and compare them with similar patients who did not experience a cardiac arrest. Methods: Retrospective control study in patients with single-ventricle physiology who underwent Norwood, Blalock-Taussig shunt, pulmonary artery band, and aortic arch repair from 2013 to 2018. Electronic medical records were obtained for all included patients. For each subject, 6 h of ECG data were analyzed. In the arrest group, the end of the sixth hour coincides with the cardiac arrest. In the control group, the 6-h windows were randomly selected. We used a Markov chain framework and the likelihood ratio test to measure the degree of ECG instability and to classify the arrest and control groups. Results: The study dataset consists of 38 cardiac arrest events and 67 control events. Our Markov model was able to classify the arrest and control groups based on the ECG instability with an ROC AUC of 82% at the hour preceding the cardiac arrests. Conclusion: We designed a method using the Markov chain framework to measure the level of instability in the beat-to-beat ECG morphology. Furthermore, we were able to show that the Markov model performed well to distinguish patients in the arrest group compared to the control group.
MeSH term(s)	Humans ; Electrocardiography ; Treatment Outcome ; Retrospective Studies ; Heart Ventricles ; Pulmonary Artery ; Heart Arrest/diagnosis
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2023.05.011
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Zs.A 701: Show issues

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Article ; Online: Hemodynamic Response to Fluid Boluses in Patients with Single-Ventricle Parallel Circulation.

Savorgnan, Fabio / Flores, Saul / Loomba, Rohit S / Acosta, Sebastian

Pediatric cardiology

2022 Volume 43, Issue 8, Page(s) 1784–1791

Abstract: The purpose of this study is to assess the effect of fluid bolus in response to a hypotensive episode by evaluating high-fidelity hemodynamic data obtained from children with single-ventricle anatomy and parallel circulation. Single center, retrospective ...

Abstract	The purpose of this study is to assess the effect of fluid bolus in response to a hypotensive episode by evaluating high-fidelity hemodynamic data obtained from children with single-ventricle anatomy and parallel circulation. Single center, retrospective analysis of hemodynamic and oximetric data after fluid bolus administrations within the first 2 weeks post-surgery. A baseline (- 60 to - 10 min), hypotensive episode (- 10 to 0 min), and response interval (0 to 60 min) were defined to quantify the dynamics of vital signs. The responses assessed include heart rate, blood pressure, oxygen saturation, oxygen extraction ratios, and pulmonary-to-systemic flow ratios. Mixed effects models were used to account for the repeated measures over the response interval. The analysis included 67 fluid boluses. There is a decrease in heart rate and an increase in blood pressure during the response in comparison to the hypotensive time. These vitals rapidly return to the baseline values. The boluses induced a significant decrease in renal and cerebral oxygen extraction ratios, with no significant change in arterial oxygen saturation or pulmonary-to-systemic flow ratio. The type of bolus (normal saline versus albumin) did not affect the response in blood pressure. However, in comparison with albumin, normal saline had a more favorable effect on the renal and cerebral oxygen extraction ratios. This study demonstrates that fluid boluses are an effective rescue medication for hypotensive episodes in children with parallel circulation by improving hemodynamics, as well as markers of oxygen delivery. The type of bolus (normal saline versus albumin) did not affect the blood pressure response. However, normal saline had a more pronounced effect on the renal and cerebral oxygen extraction ratios than albumin.
MeSH term(s)	Child ; Humans ; Albumins/pharmacology ; Hemodynamics ; Oxygen ; Retrospective Studies ; Saline Solution/pharmacology ; Hypotension/therapy
Chemical Substances	Albumins ; Oxygen (S88TT14065) ; Saline Solution
Language	English
Publishing date	2022-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	800857-7
ISSN	1432-1971 ; 0172-0643
ISSN (online)	1432-1971
ISSN	0172-0643
DOI	10.1007/s00246-022-02915-y
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Zs.A 1528: Show issues

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Article: Hemodynamic and Oximetric Response to Sodium Bicarbonate Boluses in Children with Single Ventricle Parallel Circulation: A Retrospective, Single-Center Study

Savorgnan, Fabio / Flores, Saul / Loomba, Rohit S. / Acosta, Sebastian

Journal of Pediatric Intensive Care

2023

Abstract: The aim of the study was to evaluate the hemodynamic and oximetric changes in patients with parallel circulation (Norwood, hybrid, and BT-shunted) after sodium bicarbonate bolus administration. This study was a retrospective analysis of physiologic data. ...

Abstract	The aim of the study was to evaluate the hemodynamic and oximetric changes in patients with parallel circulation (Norwood, hybrid, and BT-shunted) after sodium bicarbonate bolus administration. This study was a retrospective analysis of physiologic data. To eliminate confounders, sodium bicarbonate boluses concurrently administered with normal saline, 5% albumin, epinephrine boluses, blood transfusions, change in vasoactive inotropic score or mechanical circulatory support were excluded. Blood pressure, arterial oxygen saturation, heart rate (HR), and cerebral and renal near infrared spectroscopy were continuously recorded from 1-hour pre to 1-hour post each intervention. Out of 429 boluses, 293 boluses met the inclusion criteria. Measurements show an increase in blood pressure ( p = 0.01) and HR ( p < 0.01), and a decrease in pulmonary-to-systemic flow ratio ( p = 0.02) and renal oxygen extraction ratio (rOER) ( p = 0.04) at some point during the first hour postbolus. The arterial oxygen saturation increased, and the rOER decreased for those patients with pre-bolus pH < 7.20 and/or pre-bolus serum bicarbonate level < 18 mEq/L, according to linear regression models ( p < 0.05). Sodium bicarbonate was associated with improvement of hemodynamic and oximetric parameters in this cohort, particularly for those patients with pH < 7.20 and/or serum bicarbonate level < 18 mEq/L. This finding is consistent with an increase in cardiac output due to the removal of the acidotic negative inotropic effect by the sodium bicarbonate.
Keywords	sodium bicarbonate bolus ; single ventricle ; parallel circulation ; hemodynamic ; oximetry
Language	English
Publishing date	2023-02-24
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2146-4626 ; 2146-4618
ISSN (online)	2146-4626
ISSN	2146-4618
DOI	10.1055/s-0043-1762911
Database	Thieme publisher's database

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Article ; Online: Noninvasive Respiratory Support Does Not Prevent Extubation Failure in High-Risk Norwood Patients.

Hassan, Adel M / Acosta, Sebastian / Zheng, Feng / Rusin, Craig / Savorgnan, Fabio

Critical care explorations

2022 Volume 4, Issue 10, Page(s) e0782

Abstract: This study aims to determine whether bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) effectively mitigate the risk of extubation failure in children status post-Norwood procedure.: Design: Single-center, ... ...

Abstract	This study aims to determine whether bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) effectively mitigate the risk of extubation failure in children status post-Norwood procedure. Design: Single-center, retrospective analysis. Extubation events were collected from January 2015 to July 2021. Extubation failure was defined as the need for reintubation within 48 hours of extubation. Demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations. Setting: Pediatric cardiovascular ICU. Patients: Neonates following Norwood procedure. Interventions: Extubation following the Norwood procedure. Measurements and main results: The analysis included 311 extubations. Extubation failure occurred in 31 (10%) extubation attempts within the first 48 hours. On univariate analysis, higher rate of extubation failure was observed when patients were extubated to CPAP/BiPAP relative to patients who were extubated to either high-flow nasal cannula (HFNC) or nasal cannula (NC) (16% vs 7.8%; Conclusions: Clinicians should not rely on CPAP or BiPAP as the only supportive measure for a patient at increased risk of extubation failure. CPAP or BiPAP do not mitigate the risk of extubation failure in the Norwood patients. A multisite study is needed to generalize these conclusions.
Language	English
Publishing date	2022-10-25
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000782
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Article ; Online: Quantification of electrocardiogram instability prior to cardiac arrest in patients with single-ventricle physiology.

Savorgnan, Fabio / Crouthamel, Daniel I / Heroy, Andy / Santerre, John / Acosta, Sebastian

Journal of electrocardiology

2022 Volume 73, Page(s) 29–33

Abstract: Objective: To quantify the instability measured in the electrocardiogram (ECG) waveform in patients with single-ventricle physiology before a cardiac arrest and compare with similar patients who did not have a cardiac arrest.: Methods: We measure the ...

Abstract	Objective: To quantify the instability measured in the electrocardiogram (ECG) waveform in patients with single-ventricle physiology before a cardiac arrest and compare with similar patients who did not have a cardiac arrest. Methods: We measure the instability in the ECG morphology using variance, entropy, and decorrelation of polynomial fit coefficients of the beat-to-beat segmented data. These three metrics quantify the spread of the ECG morphology, the lack of beat-to-beat periodicity and the lack of predictability, respectively. For each subject, 3 h of ECG data were analyzed. In the arrest group, the end of the third hour coincides with the cardiac arrest. In the control group, the 3-h windows were randomly selected. Results: The study dataset consists of 38 cardiac arrest events and 67 control events. In the hour prior to the cardiac arrest, the variance, entropy, and decorrelation of the polynomial fit coefficients were higher in the arrest group than in the control group (p = 0.003, p = 0.009, and p = 0.035, respectively). For the second and third hours prior to the arrests, the differences in variance, entropy, and decorrelation between the arrest and control groups lost statistical significance. Using these metrics of instability as predictive features in a support vector machine algorithm, we found an area under the receiver operating characteristic curve of 0.8 to distinguish the arrest event from the control events. Conclusion: By taking a holistic assessment of the ECG waveform in patients with single-ventricle physiology to measure the instability in its beat-to-beat morphology, the ECG waveform variance, entropy, and decorrelation are found to be statistically different in the patients who arrested compared with patients in the control group.
MeSH term(s)	Algorithms ; Electrocardiography ; Humans ; Out-of-Hospital Cardiac Arrest ; ROC Curve
Language	English
Publishing date	2022-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2022.05.001
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Article ; Online: Association of Area Deprivation Index With Severity of COVID-19 in Pediatric Patients: A Multisite Study of Racially and Ethnically Diverse Children.

Acosta, Sebastian / Suresh, Srinivasan / Ettinger, Anna K / Savorgnan, Fabio / Annapragada, Ananth / Kannikeswaran, Nirupama / Sethuraman, Usha

The Pediatric infectious disease journal

2023 Volume 42, Issue 6, Page(s) e197–e200

Abstract: Area deprivation index (ADI) is associated with the risk of severe COVID-19 in adults. However, this association has not been established in children. Information on ADI, demographics, clinical features, disease severity, and outcomes was analyzed for ... ...

Abstract	Area deprivation index (ADI) is associated with the risk of severe COVID-19 in adults. However, this association has not been established in children. Information on ADI, demographics, clinical features, disease severity, and outcomes was analyzed for 3434 children with COVID-19. A multivariate logistic regression revealed that non-Hispanic Asians, extremes of weight, and higher ADI were associated with severe disease.
MeSH term(s)	Adult ; Humans ; Child ; COVID-19 ; Patient Acuity ; Residence Characteristics ; Logistic Models ; Retrospective Studies
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003888
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