Preventing Cardiac Arrest in the Pediatric Cardiac Intensive Care Unit Through Multicenter Collaboration
Authors: Alten Jeffrey , Cooper David S. , Klugman Darren , Raymond Tia Tortoriello , Wooton Sharyl , Garza Janie , Clarke-Myers Katherine , Anderson Jeffrey , Pasquali Sara K. , Absi Mohammed , Affolter Jeremy T. , Bailly David K. , Bertrandt Rebecca A. , Borasino Santiago , Dewan Maya , Domnina Yuliya , Lane John , McCammond Amy N. , Mueller Dana M. , Olive Mary K. , Ortmann Laura , Prodhan Parthak , Sasaki Jun , Scahill Carly , Schroeder Luke W. , Werho David K. , Zaccagni Hayden , Zhang Wenying , Banerjee Mousumi , Gaies Michael ,   PC4 CAP Collaborators, Florez Amy R. , Mah Kenneth , Murphy Lee D. , Louden Emily , Moellinger Ashley , Scalici McAtee Maria , Kane Janie , Roper Stephanie , Bradley Brittany , Dick Ashley , Bhakta Rupal T. , Das Ashima , Shah Tejas , Burton Grant , Manzuri Shai , Briceno-Medina Mario , Grandberry Michelle H. , Diddle J Welsey , Riley Christine M. , Fortkiewicz Justine M. , Hom Lisa A. , Parikh Kinjal , Almasarweh Saleem , Kayoum Anas Abdul , Koch Josh , Richardson Amanda , Wellnitz Chasity , Delgado-Corcoran Claudia , Hardin-Reynolds Trudy , Do Thomas B. , Wilhelmi Amy J. , McMorrow Sciuto Siobhán , Daley Sean , Wolovits Joshua S. , Yu Priscilla , Gerstmann Julia , Mannan Terri , Buckley Jason R. , Tabbutt Sara , Chan Titus , Davis Arianna , Hammel James , Burgert Alyss , Norton Bridget , Molitor-Kirsch Erica , Miller-Smith Laura , Tieves Kelly S. , Walz Kayla , Rosenberg Colleen , Owens Gabe E. , Mikesell Katherine , Wald Eric , Clark Jade , Laubhan Calypso , DiMaria Kimberly , Wilkes Ryan , Steadman Page , Davis Amanda L. , Smith Amanda , Lasa Javier J. , Zahn-Schafer Rebecca , Maynord Patrick , Smith Andrew Harold , Mastropietro Christopher W. , Broo Monica , Vinson Erica , Duncan Linda , Kluck Jane , Ruiz Michelle , Gretchen Catherine , Moga Michael-Alice 
Published: July 2022

Importance

Preventing in-hospital cardiac arrest (IHCA) likely represents an effective strategy to improve outcomes for critically ill patients, but feasibility of IHCA prevention remains unclear.

Objective

To determine whether a low-technology cardiac arrest prevention (CAP) practice bundle decreases IHCA rate.

Design, Setting, and Participants

Pediatric cardiac intensive care unit (CICU) teams from the Pediatric Cardiac Critical Care Consortium (PC4) formed a collaborative learning network to implement the CAP bundle consistent with the Institute for Healthcare Improvement framework; 15 hospitals implemented the bundle voluntarily. Risk-adjusted IHCA incidence rates were analyzed across 2 time periods, 12 months (baseline) and 18 months after CAP implementation (intervention) using difference-in-differences (DID) regression to compare 15 CAP and 16 control PC4 hospitals that chose not to participate in CAP but had IHCA rates tracked in the PC4 registry. Patients deemed at high risk for IHCA, based on a priori evidence-based criteria and empirical hospital-specific criteria, were selected to receive the CAP bundle. Data were collected from July 2018 to December 2019, and data were analyzed from March to August 2020.

Interventions

CAP bundle included 5 elements developed to promote increased situational awareness and communication among bedside clinicians to recognize and mitigate deterioration in high-risk patients.

Main Outcomes and Measures

Risk-adjusted IHCA incidence rate across all CICU admissions (IHCA events divided by all admissions).

Results

The bundle was activated in 2664 of 10 510 CAP hospital admissions (25.3%); admission characteristics were similar across study periods. There was a 30% relative reduction in risk-adjusted IHCA incidence rate at CAP hospitals (intervention period: 2.6%; 95% CI, 2.2-2.9; baseline: 3.7%; 95% CI, 3.1-4.0), but no change at control hospitals (intervention period: 2.7%; 95% CI, 2.3-2.9; baseline: 2.7%; 95% CI, 2.2-3.0). DID analysis confirmed significantly reduced odds of IHCA among all admissions at CAP hospitals compared with control hospitals during the intervention period vs baseline (odds ratio, 0.72; 95% CI, 0.56-0.91; P = .01). DID odds ratios were 0.72 (95% CI, 0.53-0.98) for the surgical subgroup, 0.74 (95% CI, 0.48-1.14) for the medical subgroup, and 0.72 (95% CI, 0.50-1.03) for the high-risk admission subgroup at CAP hospitals after intervention. All-cause risk-adjusted mortality rate did not change after intervention.

Conclusions and Relevance

Implementation of this CAP bundle led to significant IHCA reduction across multiple pediatric CICUs. Future studies may determine if this bundle can be effective in other critically ill populations.