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

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.