Collaborative Learning

(Observational Study)

Study Summary

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.


CPG Developed

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.

499 Medical Records Reviewed

240 subjects were enrolled at the 4 active sites and 259 subjects were enrolled at the 5 control sites.

From 11.7% to 66.9%

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.

Who was in the study?

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.

What happened in the study?

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.

What were the results of the study?

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.

Study Publications

  • Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery

    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.

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  • Rationale and Methodology of a Collaborative Learning Project in Congenital Cardiac Care

    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.

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  • Hospital Costs Related to Early Extubation After Infant Cardiac Surgery

    K. E. McHugh, Ann Thorac Surg. 2019 May;107(5):1421-1426.

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