The Collaborative Learning study compared how well babies did after surgery at heart centers where babies were removed from the ventilator early (called early extubation and defined as within six hours of arrival to the ICU) versus at sites that would practice according to their usual routine.
The study had 5 “active sites” which developed and followed a clinical practice guideline (CPG) about how to perform early extubation safely and effectively. Five sites followed their routine practice. The study assessed early extubation in infants with Tetralogy of Fallot or coarctation of the aorta.
We used the collaborative learning approach to develop a clinical practice guideline (CPG) to increase the rate of early extubation at active sites in infants with two different heart defects.
240 subjects were enrolled at the 4 active sites and 259 subjects were enrolled at the 5 control sites.
After CPG implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p<0.001) with no increase in reintubation rate.
Data were collected on babies who had Tetralogy of Fallot or coarctation of the aorta and who were undergoing surgical repair. The data were analyzed at active sites which followed the CPG to extubate babies early compared to sites which did not follow the CPG, to see if babies do the same, better or worse.
This study reviewed the medical charts of infants from sites that adopted the CPG to extubate early versus sites that performed their normal routine. Data collected included individual level data on sedation, pain scores, ventilator support, and length of stay; cost assessment data; and system level assessments.
The clinical practice guideline significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation clinical practice guideline did not significantly change postoperative ICU length of stay or hospital length of stay.
W. T. Mahle, Pediatr Crit Care Med; 2016 Oct;17(10):939-947.
This study compared how well babies did after surgery, for Tetralogy of Fallot or coarctation of the aorta, at research sites where babies were removed from the ventilator early (called early extubation) versus at research sites where babies were not taken off the ventilators early. The clinical practice guideline used at the intervention sites significantly increased the rate of early extubation with no change in the rate of reintubation or postoperative ICU length of stay.
M. J. Wolf, Am Heart J; 2016 Apr;174:129-37.
This paper describes how collaborative learning was used to develop a clinical practice guideline to design a study examining early extubation of babies after heart surgery.
K. E. McHugh, Ann Thorac Surg. 2019 May;107(5):1421-1426.