Bio

Clinical Focus


  • Pediatric Critical Care Medicine

Academic Appointments


Professional Education


  • Board Certification: American Board of Pediatrics, Pediatric Critical Care Medicine (2008)
  • Fellowship: University of Michigan GME Training Verifications (2007) MI
  • Fellowship: Baylor College Pediatric Cardiology Residency at Texas Childrens Hospital (2002) TX
  • Residency: Childrens National Medical Center Pediatric Residency (1998) DC
  • Medical Education: Southern Illinois University School of Medicine Registrar (1995) IL

Teaching

Publications

All Publications


  • Acute kidney injury after in-hospital cardiac arrest. Resuscitation Mah, K. E., Alten, J. A., Cornell, T. T., Selewski, D. T., Askenazi, D. n., Fitzgerald, J. C., Topjian, A. n., Page, K. n., Holubkov, R. n., Slomine, B. S., Christensen, J. R., Dean, J. M., Moler, F. W. 2021

    Abstract

    Determine 1) frequency and risk factors for acute kidney injury (AKI) after in-hospital cardiac arrest (IHCA) in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial and associated outcomes; 2) impact of temperature management on post-IHCA AKI.Secondary analysis of THAPCA-IH; a randomized controlled multi-national trial at 37 children's hospitals.Serum creatinine (Cr) within 24 h of randomization.Prevalence of severe AKI defined by Stage 2 or 3 Kidney Disease Improving Global Outcomes Cr criteria. 12-month survival with favorable neurobehavioral outcome. Analyses stratified by entire cohort and cardiac subgroup. Risk factors and outcomes compared among cohorts with and without severe AKI.Subject randomization: 159 to hypothermia, 154 to normothermia. Overall, 80% (249) developed AKI (any stage), and 66% (207) developed severe AKI. Cardiac patients (204, 65%) were more likely to develop severe AKI (72% vs 56%,p = 0.006). Preexisting cardiac or renal conditions, baseline lactate, vasoactive support, and systolic blood pressure were associated with severe AKI. Comparing hypothermia versus normothermia, there were no differences in severe AKI rate (63% vs 70%,p = 0.23), peak Cr, time to peak Cr, or freedom from mortality or severe AKI (p = 0.14). Severe AKI was associated with decreased hospital survival (48% vs 65%,p = 0.006) and decreased 12-month survival with favorable neurobehavioral outcome (30% vs 53%,p < 0.001).Severe post-IHCA AKI occurred frequently especially in those with preexisting cardiac or renal conditions and peri-arrest hemodynamic instability. Severe AKI was associated with decreased survival with favorable neurobehavioral outcome. Hypothermia did not decrease incidence of severe AKI post-IHCA.

    View details for DOI 10.1016/j.resuscitation.2020.12.023

    View details for PubMedID 33450335

  • Clinician Accuracy in Identifying and Predicting Organ Dysfunction in Critically Ill Children. Critical care medicine Carlton, E. F., Close, J., Paice, K., Dews, A., Gorga, S. M., Sturza, J., Barbaro, R. P., Cornell, T. T., Prescott, H. C. 2020

    Abstract

    OBJECTIVES: To determine clinician accuracy in the identification and prediction of multiple organ dysfunction syndrome.DESIGN: Prospective cohort study.SETTING: University of Michigan's C.S. Mott Children's Hospital PICU.PATIENTS: Patients admitted to the PICU with an anticipated PICU length of stay greater than 48 hours.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: For each patient, the clinical team (attending, fellow, resident/nurse practitioner) was surveyed regarding existing and anticipated organ dysfunction. The primary outcomes were clinicians' accuracy at identifying multiple organ dysfunction syndrome and predicting new or progressive multiple organ dysfunction syndrome, compared to the objective assessment of multiple organ dysfunction syndrome using Proulx criteria. We also measured sensitivity, specificity, negative and positive predictive values, and negative and positive likelihood ratios of clinician assessments. We tested for differences in accuracy by clinician type using chi-square tests. Clinicians rated their confidence in prediction on a 5-point Likert scale. There were 476 eligible PICU admissions, for whom 1,218 surveys were completed. Multiple organ dysfunction syndrome was present in 89 patients (18.7%) at enrollment, and new or progressive multiple organ dysfunction syndrome occurred in 39 (8.2%). Clinicians correctly identified multiple organ dysfunction syndrome with 79.9% accuracy and predicted additional organ dysfunction with 82.6% accuracy. However, the positive and negative likelihood ratios for new or progressive multiple organ dysfunction syndrome prediction were 3.0 and 0.7, respectively, indicating a weak relationship between the clinician prediction and development of new or progressive multiple organ dysfunction syndrome. The positive predictive value of new or progressive multiple organ dysfunction syndrome prediction was just 22.1%. We found no differences in accuracy by clinician type for either identification of multiple organ dysfunction syndrome (80.2% vs 78.2% vs 81.0%; p = 0.57) or prediction of new or progressive multiple organ dysfunction syndrome (84.8% vs 82.8% vs 80.3%; p = 0.26) for attendings, fellows, and residents/nurse practitioners, respectively. There was a weak correlation between the confidence and accuracy of prediction (pairwise correlation coefficient, 0.26; p < 0.001).CONCLUSIONS: PICU clinicians correctly identified multiple organ dysfunction syndrome and predicted new or progressive multiple organ dysfunction syndrome with 80% accuracy. However, only 8% of patients developed new or progressive multiple organ dysfunction syndrome, so accuracy was largely due to true negative predictions. The positive predictive value for new or progressive multiple organ dysfunction syndrome prediction was just 22%. Accuracy did not differ by clinician type, but was correlated with self-rated confidence and was higher for negative predictions.

    View details for DOI 10.1097/CCM.0000000000004555

    View details for PubMedID 32804793

  • New Medical Device Acquisition During Pediatric Severe Sepsis Hospitalizations. Critical care medicine Carlton, E. F., Donnelly, J. P., Hensley, M. K., Cornell, T. T., Prescott, H. C. 2020

    Abstract

    Severe sepsis is a significant cause of healthcare utilization and morbidity among pediatric patients. However, little is known about how commonly survivors acquire new medical devices during pediatric severe sepsis hospitalization. We sought to determine the rate of new device acquisition (specifically, tracheostomy placement, gastrostomy tube placement, vascular access devices, ostomy procedures, and amputation) among children surviving hospitalizations with severe sepsis. For contextualization, we compare this to rates of new device acquisition among three comparison cohorts: 1) survivors of all-cause pediatric hospitalizations; 2) matched survivors of nonsepsis infection hospitalizations; and 3) matched survivors of all-cause nonsepsis hospitalization with similar organ dysfunction.Observational cohort study.Nationwide Readmission Database (2016), including all-payer hospitalizations from 27 states.Eighteen-thousand two-hundred ten pediatric severe sepsis hospitalizations; 532,738 all-cause pediatric hospitalizations; 16,173 age- and sex-matched nonsepsis infection hospitalizations; 15,025 organ dysfunction matched all-cause nonsepsis hospitalizations; and all with live discharge.Among 18,210 pediatric severe sepsis hospitalizations, 1,024 (5.6%) underwent device placement. Specifically, 3.5% had new gastrostomy, 3.1% new tracheostomy, 0.6% new vascular access devices, 0.4% new ostomy procedures, and 0.1% amputations. One-hundred forty hospitalizations (0.8%) included two or more new devices. After applying the Nationwide Readmissions Database sampling weights, there were 55,624 pediatric severe sepsis hospitalizations and 1,585,194 all-cause nonsepsis hospitalizations with live discharge in 2016. Compared to all-cause pediatric hospitalizations, severe sepsis hospitalizations were eight-fold more likely to involve new device acquisition (6.4% vs 0.8%; p < 0.001). New device acquisition was also higher in severe sepsis hospitalizations compared with matched nonsepsis infection hospitalizations (5.1% vs 1.2%; p < 0.01) and matched all-cause hospitalizations with similar organ dysfunction (4.7% vs 2.8%; p < 0.001).In this nationwide, all-payer cohort of U.S. pediatric severe sepsis hospitalizations, one in 20 children surviving severe sepsis experienced new device acquisition. The procedure rate was nearly eight-fold higher than all-cause, nonsepsis pediatric hospitalizations, and four-fold higher than matched nonsepsis infection hospitalizations.

    View details for DOI 10.1097/CCM.0000000000004272

    View details for PubMedID 32108704

  • Cardiac Dysfunction Identified by Strain Echocardiography Is Associated With Illness Severity in Pediatric Sepsis. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Patel, M. D., Mariano, K. n., Dunbar, T. n., Cornell, T. T., Punn, R. n., Haileselassie, B. n. 2020

    Abstract

    Sepsis-induced myocardial dysfunction has been associated with illness severity and mortality in pediatrics. Although early sepsis-induced myocardial dysfunction diagnosis could aid in hemodynamic management, current echocardiographic metrics for assessing biventricular function are limited in detecting early impairment. Strain echocardiography is a validated quantitative measure that can detect subtle perturbations in left ventricular and right ventricular function. This investigation evaluates the utility of strain echocardiography in pediatric sepsis and compares with to conventional methods.Retrospective, observational study comparing left ventricular and right ventricular strain. Strain was compared with ejection fraction and fractional shortening and established sepsis severity of illness markers.Tertiary care medical-surgical PICU from July 2013 to January 2018.Seventy-nine septic children and 28 healthy controls.None.Compared with healthy controls, patients with severe sepsis demonstrated abnormal left ventricular strain (left ventricular longitudinal strain: -13.0% ± 0.72; p = 0.04 and left ventricular circumferential strain: -16.5% ± 0.99; p = 0.046) and right ventricular (right ventricular longitudinal strain = -14.3% ± 6.3; p < 0.01) despite normal fractional shortening (36.0% ± 1.6 vs 38.1% ± 1.1; p = 0.5129) and ejection fraction (60.7% ± 2.2 vs 65.3% ± 1.5; p = 0.33). There was significant association between depressed left ventricular longitudinal strain and increased Vasotrope-Inotrope Score (r = 0.52; p = 0.034). Worsening left ventricular circumferential strain was correlated with higher lactate (r = 0.31; p = 0.03) and higher Pediatric Risk of Mortality-III score (r = 0.39; p < 0.01). Depressed right ventricular longitudinal strain was associated with elevated pediatric multiple organ dysfunction score (r = 0.44; p < 0.01) CONCLUSIONS:: Compared with healthy children, pediatric septic patients demonstrated abnormal left ventricular and right ventricular strain concerning for early signs of cardiac dysfunction. This was despite having normal ejection fraction and fractional shortening. Abnormal strain was associated with abnormal severity of illness markers. Strain echocardiography may have utility as an early indicator of sepsis-induced myocardial dysfunction in pediatric sepsis.

    View details for DOI 10.1097/PCC.0000000000002247

    View details for PubMedID 32084099

  • Characteristics of Pediatric Extracorporeal Membrane Oxygenation Programs in the United States and Canada. ASAIO journal (American Society for Artificial Internal Organs : 1992) Troy, L. n., Su, F. n., Kilbaugh, T. n., Rasmussen, L. n., Kuo, T. n., Jett, E. n., Cornell, T. n., Berg, M. n., Haileselassie, B. n. 2020

    Abstract

    The aim of this study was to evaluate the current infrastructure and practice characteristics of pediatric extracorporeal membrane oxygenation (ECMO) programs. A 40-question survey of center-specific demographics, practice structure, program experience, and support network utilized to cannulate and maintain a pediatric patient on ECMO was designed via a web-based survey tool. The survey was distributed to pediatric ECMO programs in the United States and Canada. Of the 101 centers that were identified to participate, 41 completed the survey. The majority of responding centers are university affiliated (73%) and have an intensive care unit (ICU) with 15-25 beds (58%). Extracorporeal membrane oxygenation has been offered for >10 years in 85% of the centers. The median number of total cannulations per center in 2017 was 15 (interquartile range [IQR] = 5-30), with the majority occurring in the cardiovascular intensive care unit (median = 13, IQR = 5-25). Fifty-seven percent of responding centers offer ECPR, with a median number of four cases per year (IQR = 2-7). Most centers cannulate in an operating room or ICU; 11 centers can cannulate in the pediatric ED. Sixty-three percent of centers have standardized protocols for postcannulation management. The majority of protocols guide anticoagulation, sedation, or ventilator management; left ventricle decompression and reperfusion catheter placement are the least standardized procedures. The majority of pediatric ECMO centers have adopted the infrastructure recommendations from the Extracorporeal Life Support Organization. However, there remains broad variability of practice characteristics and organizational infrastructure for pediatric ECMO centers across the United States and Canada.

    View details for DOI 10.1097/MAT.0000000000001311

    View details for PubMedID 33181543

  • The American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Executive Summary PEDIATRIC CRITICAL CARE MEDICINE Davis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C., Okhuysen-Cawley, R. S., Relvas, M. S., Rozenfeld, R. A., Skippen, P. W., Stojadinovic, B. J., Williams, E. A., Yeh, T. S., Balamuth, F., Brierley, J., de Caen, A. R., Cheifetz, I. M., Choong, K., Conway, E., Cornell, T., Doctor, A., Dugas, M., Feldman, J. D., Fitzgerald, J. C., Flori, H. R., Fortenberry, J. D., Graciano, A., Greenwald, B. M., Hall, M. W., Han, Y., Hernan, L. J., Irazuzta, J. E., Iselin, E., van der Jagt, E. W., Jeffries, H. E., Kache, S., Katyal, C., Kissoon, N., Kon, A. A., Kutko, M. C., MacLaren, G., Maul, T., Mehta, R., Odetola, F., Parbuoni, K., Paul, R., Peters, M. J., Ranjit, S., Reuter-Rice, K. E., Schnitzler, E. J., Scott, H. F., Torres, A., Weingarten-Abrams, J., Weiss, S. L., Zimmerman, J. J., Zuckerberg, A. L. 2017; 18 (9): 884–90

    View details for PubMedID 28723883

  • American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock CRITICAL CARE MEDICINE Davis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C., Okhuysen-Cawley, R. S., Relvas, M. S., Rozenfeld, R. A., Skippen, P. W., Stojadinovic, B. T., Williams, E. A., Yeh, T. S., Balamuth, F., Brierley, J., de Caen, A. R., Cheifetz, I. M., Choong, K., Conway, E., Cornell, T., Doctor, A., Dugas, M., Feldman, J. D., Fitzgerald, J. C., Flori, H. R., Fortenberry, J. D., Graciano, A. L., Greenwald, B. M., Hall, M. W., Han, Y. Y., Hernan, L. J., Irazurta, J. E., Iselin, E., van der Jagt, E. W., Jeffries, H. E., Kache, S., Katyal, C., Kissoon, N. T., Kon, A. A., Kutko, M. C., MacLaren, G., Maul, T., Mehta, R., Odetola, F., Parbuoni, K., Paul, R., Peters, M. J., Ranjit, S., Reuter-Rice, K. E., Schnitzler, E. J., Scott, H. F., Torres, A., Weingarten-Abrams, J., Weiss, S. L., Zimmerman, J. J., Zuckerberg, A. L. 2017; 45 (6): 1061-1093

    Abstract

    The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014). The PubMed/Medline/Embase literature (2006-14) was searched by the Society of Critical Care Medicine librarian using the keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation, and American College of Critical Care Medicine guidelines in the newborn and pediatric age groups.The 2002 and 2007 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and American Heart Association/Pediatric Advanced Life Support sanctioned recommendations. The review of new literature highlights two tertiary pediatric centers that implemented quality improvement initiatives to improve early septic shock recognition and first-hour compliance to these guidelines. Improved compliance reduced hospital mortality from 4% to 2%. Analysis of Global Sepsis Initiative data in resource rich developed and developing nations further showed improved hospital mortality with compliance to first-hour and stabilization guideline recommendations.The major new recommendation in the 2014 update is consideration of institution-specific use of 1) a "recognition bundle" containing a trigger tool for rapid identification of patients with septic shock, 2) a "resuscitation and stabilization bundle" to help adherence to best practice principles, and 3) a "performance bundle" to identify and overcome perceived barriers to the pursuit of best practice principles.

    View details for DOI 10.1097/CCM.0000000000002425

    View details for PubMedID 28509730

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