COMPARISON OF DEVICES USED FOR POSITIVE PRESSURE VENTILATION DURING NEWBORN RESUSCITATION

Abstract

BACKGROUND: The IWK Health Centre in Halifax, Nova Scotia provides pediatric cardiac services for the Maritime Provinces of Canada. In order to provide a timely echocardiogram (echo) service for new and follow-up patients over this wide geographic area, several sites have adult sonographers cross-trained in pediatric echocardiography. These sites perform echoes locally and mail recorded studies to the IWK Health Centre for interpretation by pediatric cardiologists, also known as external echoes. The objective of this study is to describe the use and outcomes from this service. METHODS: All external echoes with requisition sheets from August 1, 2013 to July 31, 2014 were reviewed. Demographic, echo interpretation and any subsequent follow up data were collected. RESULTS: There were 841 external echoes interpreted at the IWK Health Centre during the study period. Nineteen percent (163) of the echoes were performed on children less than one month of age and another 20% (172) were performed on children less than one year of age. The majority of echoes, 76.7% (645), were performed in New Brunswick: Moncton 28.9% (243), Bathurst 19.3% (162), Fredericton 15% (126), and Saint John 13.4% (113). The remaining echoes were performed in Sydney, Nova Scotia (12.6%, 106) and Charlottetown, Prince Edward Island (10.5%, 88). The ordering physicians were general pediatricians 80% (674), IWK cardiologists 6.4% (64), neonatologists 5.2% (44), family physicians 5.1% (43), or other pediatric specialties such as oncology 2.3% (19). Of the 356 echoes performed for murmurs, 44% (158) were normal. Of all referred in echoes, 3.2% (27) were concerning enough to warrant urgent transfers to the IWK Health Centre and 18.9% (159) resulted in elective referrals to cardiology. Based on the distances from the IWK Health Centre to these other cities in the Maritimes, 312,986 km of patient travel were saved. CONCLUSION: This regional referred in pediatric echocardiogram interpretation service is unique and provided services otherwise only attainable in Halifax, saving patients significant travel time and expenses. The majority of those echoed were normal, making available cardiology referral resources for other patients. External echocardiograms are a valuable service that improves accessibility to pediatric echo services.