PEDS14: Evolution of pediatric ventricular assist device care beyond the Intensive Care Unit (ICU): A single center experience

Background: An increasing number of children on VADs are cared for outside an ICU, in an acute cardiac care unit (ACCU) once stabilized, in efforts to promote rehabilitation, quality of life, and cost-effectiveness. Despite this trend, no publications have described ACCU candidate selection, nor outcomes after transfer. We sought to describe patient characteristics, acuity of care and adverse events of pediatric VAD patients in our institution’s ACCU. Methods: We retrospectively reviewed VAD recipients <18 years of age from January 2018-December 2021. Demographic data, length of stay, ICU readmission and adverse events, as defined by the ACTION learning network, were collected. Results: ACCU nursing educational programs and streamlined team communication pathways for VAD patient concerns were developed in 2017. Among 28 patients receiving VAD support during the study period, 15 were transferred to the ACCU for ongoing care. Devices: 11 Berlin EXCOR, 4 Heartware HVAD (LVAD 11/15, BiVAD 3/15, and 2 SVAD 2/15; one after stage 1 palliation and one after stage 2). Eleven had cardiomyopathy/myocarditis, 4 had congenital heart disease. Median age 2 years (0.1-16), median weight 12 kg (3.5-76.2), median ACCU length of stay 54 days (18-205). ICU readmission rate was 33%; however, the majority were non-cardiac related or for brief observation only (median LOS 1 day). Adverse event rates: Infection 0.44 events/100 patient days; Major bleeding 0.11 events/100 patient days; Neurological event 0.11 events/100 patient days. Conclusions: We present the first detailed description of pediatric VAD patients cared for in an ACCU. A diverse patient population was captured, including those with historically poor outcomes such as infants with SVAD and BiVAD support. Despite this, adverse event rates were low. ICU readmission was largely for observation, which may reflect institutional learning and maturation. Future directions include evaluating cost savings and including additional institutions for a broader understanding of current practices.