Browsing by Author "Gray, Brian"

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    A Multimodal Educational Boot Camp for Training Fellows in Pediatric Extracorporeal Membrane Oxygenation (ECMO)
    (Association of American Medical Colleges, 2024-10-17) Park, Yujin; Hocutt, Gail; Wetzel, Elizabeth; Swinger, Nathan; Pearson, Kellie; Abulebda, Kamal; Gray, Brian; Surgery, School of Medicine
    Introduction: Pediatric extracorporeal membrane oxygenation (ECMO) management presents unique challenges in acute care settings, requiring specialized expertise to manage critically ill children. Medical and surgical fellows often manage these patients, but prior residency training rarely provides sufficient ECMO exposure. We developed and evaluated a multimodal pediatric ECMO boot camp for new fellows. Methods: This boot camp was implemented during 5-hour sessions in August 2021, August 2022, and August 2023. The curriculum included a 45-minute introductory didactics session, 30-minute hands-on circuit demonstration, and four 30-minute small-group activity stations. To assess knowledge acquisition, pre- and posttests were administered; participants also completed a post-boot camp survey to evaluate their confidence and provide feedback. Results: Forty-nine participants completed the boot camp, including 18 critical care, four cardiology, 11 pediatric surgery, 12 cardiothoracic surgery, and four pediatric emergency medicine fellows. Pre- and posttests demonstrated significant improvement in knowledge of ECMO circuit components and pressures (56% vs. 76%, p < .001). All of our participants agreed or strongly agreed that participating in the boot camp increased their confidence in troubleshooting ECMO emergencies. The inclusion of fellows from various clinical disciplines, offering a rich diversity of perspectives, was particularly valued by participants. Discussion: Our results demonstrate the feasibility and effectiveness of establishing a pediatric ECMO boot camp to train new surgical and medical fellows. The curriculum not only improved ECMO knowledge but also boosted learners' confidence in managing ECMO-related challenges.
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    Decreasing trend of gastroschisis prevalence in the United States from 2014 through 2022: Is attributed to declining birth rates in young, high-risk gravidae
    (Elsevier, 2025-02-12) Mustafa, Hiba J.; Zargarzadeh, Nikan; Moss, Kevin L.; Abiad, May; Gray, Brian; Aagaard, Kjersti M.; Buchmiller, Terry L.; Perrone, Erin E.; Shamshirsaz, Alireza A.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Objectives: To investigate the prevalence trend of gastroschisis in the United States between 2014 and 2022. Methods: A cross-sectional retrospective analysis of the Centers for the United States live births between 2014 and 2022. Pregnancies and neonatal singleton live births with documented isolated gastroschisis were included. Neonates with other major congenital anomalies and known chromosomal abnormalities were excluded. Prevalence per 10,000 live births along with 95 % confidence intervals was estimated. Results: Among 32,088,301 singleton live births, 6804 cases of isolated gastroschisis were identified (Point prevalence: 2 in 10,000 live births). A significant decline in gastroschisis prevalence was observed, decreasing from 2.86 per 10,000 live births in 2014-1.55 per 10,000 live births in 2022 (P < 0.001). The risk of gastroschisis was significantly higher in teen and nulliparous gravidae, with prepregnancy tobacco use, and among socially vulnerable populations (underweight, < 12th-grade education, Medicaid, non-Hispanic Indigenous Americans). The drop in gastroschisis births from 2014 to 2022, compared to non-gastroschisis births, is more significant in maternal age < 20 years, nulliparous, BMI < 18.5, and in smokers prior to pregnancy than in the overall population (P = 0.02, 0.0008, <0.0001, <0.0001, and 0.01 respectively). All of the associated maternal factors had a significant decline in prevalence (P < 0.001), which may influence the decreasing trend of gastroschisis. There was no perceived considerable impact of the COVID-19 pandemic on gastroschisis trends. Conclusions: The study highlights a notable decline in gastroschisis prevalence mostly attributable to a declining birth rate in the highest at-risk strata, suggesting recent increases in birth rates among these at-risk gravidae may reverse the trend of declining gastroschisis disease prevalence. These findings support the need for ongoing further research to understand effective means of sustaining this decreasing trend.
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    Is the changing landscape of fellowship recruitment during COVID-19 here to stay?
    (Elsevier, 2022-10) Gupta, Shreya; Arthur, L. Grier; Chandler, Nicole; Danielson, Paul; Downard, Cynthia; Ehrlich, Peter; Gaines, Barbara; Gray, Brian; Javid, Patrick; Lallier, Michel; Nwomeh, Benedict; Tagge, Edward; Weiss, Richard; Tsao, KuoJen; Garrison, Aaron P.; Mak, Grace; Surgery, School of Medicine
    Background The 2020 Pediatric Surgery (PS) fellowship selection process was heavily impacted by the COVID-19 pandemic. A review of lessons learned can help determine best practices for the future. The purpose of the study was to analyze the virtual interview experience and assess opportunities to improve the post-pandemic fellowship recruitment process. Study Design Using a 28-question survey of Program Directors (PDs) of PS fellowships as well as a 44-question survey of applicants to PS fellowships in the US and Canada, we gathered information on the recruitment process during the COVID-19 pandemic (2020). Dichotomous, multiple choice and open-ended questions about the changes in process, platforms used, format, comparison to on-site interviews and overall satisfaction were used for objective and subjective feedback. Results A 95% participation rate was recorded for the PD survey. 24 out of 55 programs (44%) changed their on-site interviews to virtual format due to the pandemic. Most PDs described their overall impression of virtual interviews as satisfactory (66%, 16/24) and did not have an impact on the applicant's success in the match (35/54; 65%). About 50% of PDs preferred to have on-site interviews with virtual screening in the future. While the participation rate from applicants was much less (26 of 70), responses confirmed our survey results. Majority preferred on-site interviews (17/26), 6 of which preferred virtual screening followed by on-site interviews. Conclusion Components of virtual screening and interviews were found to have benefits financially and from both time and stress perspectives, and thus might survive past the pandemic. Levels of Evidence Level IV
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    Is the changing landscape of fellowship recruitment during COVID-19 here to stay?
    (Elsevier, 2022) Gupta, Shreya; Arthur, L. Grier; Chandler, Nicole; Danielson, Paul; Downard, Cynthia; Ehrlich, Peter; Gaines, Barbara; Gray, Brian; Javid, Patrick; Lallier, Michel; Nwomeh, Benedict; Tagge, Edward; Weiss, Richard; Tsao, KuoJen; Garrison, Aaron P.; Mak, Grace; Pediatrics, School of Medicine
    Background: The 2020 Pediatric Surgery (PS) fellowship selection process was heavily impacted by the COVID-19 pandemic. A review of lessons learned can help determine best practices for the future. The purpose of the study was to analyze the virtual interview experience and assess opportunities to improve the post-pandemic fellowship recruitment process. Study design: Using a 28-question survey of Program Directors (PDs) of PS fellowships as well as a 44-question survey of applicants to PS fellowships in the US and Canada, we gathered information on the recruitment process during the COVID-19 pandemic (2020). Dichotomous, multiple choice and open-ended questions about the changes in process, platforms used, format, comparison to on-site interviews and overall satisfaction were used for objective and subjective feedback. Results: A 95% participation rate was recorded for the PD survey. 24 out of 55 programs (44%) changed their on-site interviews to virtual format due to the pandemic. Most PDs described their overall impression of virtual interviews as satisfactory (66%, 16/24) and did not have an impact on the applicant's success in the match (35/54; 65%). About 50% of PDs preferred to have on-site interviews with virtual screening in the future. While the participation rate from applicants was much less (26 of 70), responses confirmed our survey results. Majority preferred on-site interviews (17/26), 6 of which preferred virtual screening followed by on-site interviews. Conclusion: Components of virtual screening and interviews were found to have benefits financially and from both time and stress perspectives, and thus might survive past the pandemic.
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    Ventilation Strategies during Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure: Current Approaches among Level IV Neonatal ICUs
    (Wolters Kluwer, 2022-11) Ibrahim, John; Mahmood, Burhan; DiGeronimo, Robert; Rintoul, Natalie E.; Hamrick, Shannon E.; Chapman, Rachel; Keene, Sarah; Seabrook, Ruth B.; Billimoria, Zeenia; Rao, Rakesh; Daniel, John; Cleary, John; Sullivan, Kevin; Gray, Brian; Weems, Mark; Dirnberger, Daniel R.; Surgery, School of Medicine
    OBJECTIVES: To describe ventilation strategies used during extracorporeal membrane oxygenation (ECMO) for neonatal respiratory failure among level IV neonatal ICUs (NICUs). DESIGN: Cross-sectional electronic survey. SETTING: Email-based Research Electronic Data Capture survey. PATIENTS: Neonates undergoing ECMO for respiratory failure at level IV NICUs. INTERVENTIONS: A 40-question survey was sent to site sponsors of regional referral neonatal ECMO centers participating in the Children’s Hospitals Neonatal Consortium. Reminder emails were sent at 2- and 4-week intervals. MEASUREMENTS AND MAIN RESULTS: Twenty ECMO centers responded to the survey. Most primarily use venoarterial ECMO (65%); this percentage is higher (90%) for congenital diaphragmatic hernia. Sixty-five percent reported following protocol-based guidelines, with neonatologists primarily responsible for ventilator management (80%). The primary mode of ventilation was pressure control (90%), with synchronized intermittent mechanical ventilation (SIMV) comprising 80%. Common settings included peak inspiratory pressure (PIP) of 16–20 cm H2O (55%), positive end-expiratory pressure (PEEP) of 9–10 cm H2O (40%), I-time 0.5 seconds (55%), rate of 10–15 (60%), and Fio2 22–30% (65%). A minority of sites use high-frequency ventilation (HFV) as the primary mode (5%). During ECMO, 55% of sites target some degree of lung aeration to avoid complete atelectasis. Fifty-five percent discontinue inhaled nitric oxide (iNO) during ECMO, while 60% use iNO when trialing off ECMO. Nonventilator practices to facilitate decannulation include bronchoscopy (50%), exogenous surfactant (25%), and noninhaled pulmonary vasodilators (50%). Common ventilator thresholds for decannulation include PEEP of 6–7 (45%), PIP of 21–25 (55%), and tidal volume 5–5.9 mL/kg (50%). CONCLUSIONS: The majority of level IV NICUs follow internal protocols for ventilator management during neonatal respiratory ECMO, and neonatologists primarily direct management in the NICU. While most centers use pressure-controlled SIMV, there is considerable variability in the range of settings used, with few centers using HFV primarily. Future studies should focus on identifying respiratory management practices that improve outcomes for neonatal ECMO patients.