Multicenter Quality Improvement Project to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery

Authors

• Jamie S. Penk, Northwestern University, Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago IL, USAFollow
• Tara C. Cosgrove, Nationwide Children’s Hospital, Columbus OH, USA
• Katja M. Gist, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati OH, USA
• Mathew G. Clark, Division of Pediatric Cardiology, University of Alabama at Birmingham, USA
• Samir Q. Latifi, Cleveland Clinic Children’s, Cleveland OH, USA
• Caroline A. Rodeman, Northwestern University, Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago IL, USA
• Angela M. Jarden, Cleveland Clinic Children’s, Cleveland OH, USA
• Matt Barhight, Northwestern University, Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago IL, USA
• Christina Laternser, Northwestern University, Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago IL, USA
• Rajit K. Basu, Northwestern University, Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital, Chicago IL, USA
• David S. Cooper, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati OH, USA
• Santiago Borasino, Division of Pediatric Cardiology, University of Alabama at Birmingham, USA
• Catherine D. Krawczeski, Nationwide Children’s Hospital, Columbus OH, USA
• Bradley S. Marino, Cleveland Clinic Children’s, Cleveland OH, USA

Abstract

Objective: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with morbidity. We hypothesized that the incidence and severity of AKI could be decreased by a bundle of preventative interventions. Our aim was to decrease the incidence of post-operative AKI from a baseline of 41% to <30%. Methods: Prospective multicenter quality improvement project implemented in five pediatric cardiac intensive care units. The inclusion criteria were patients under 18 years of age undergoing a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) ≥3 or Fontan operation. The bundle included: 1) Daily creatinine with AKI staging 2) Balanced fluids 3) Scheduled acetaminophen 4) Age-appropriate renal perfusion pressure 5) Nephrotoxin reduction. The primary outcome measures were incidence and severity of AKI. Results: There were 599 eligible patients in the baseline period and 480 in washout/implementation. Compared to baseline, the patients receiving the bundle underwent cardiac transplantation more frequently (10.0% versus 5.8% of total cases, p=0.01). The baseline aggregate mean incidence of any AKI was 41% and severe AKI 15%, respectively. Despite adequate bundle compliance, we observed no reduction in AKI. Conclusions: This bundle of CICU interventions did not reduce the incidence or severity of AKI in this cohort. Targeting a higher risk cohort, or starting interventions in the operating room, may be areas for future investigation.

Recommended Citation

Penk, Jamie S.; Cosgrove, Tara C.; Gist, Katja M.; Clark, Mathew G.; Latifi, Samir Q.; Rodeman, Caroline A.; Jarden, Angela M.; Barhight, Matt; Laternser, Christina; Basu, Rajit K.; Cooper, David S.; Borasino, Santiago; Krawczeski, Catherine D.; and Marino, Bradley S. (2026) "Multicenter Quality Improvement Project to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery," Journal of Pediatric Intensive Care: Vol. 15: Iss. 1, Article 6.
DOI: https://doi.org/10.53391/2146-4618.1079
Available at: https://jpic.researchcommons.org/journal/vol15/iss1/6