Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units
Authors: Mueller Dana , Bailly David K. , Banerjee Mousumi , Bertrandt R.A. , Borasino Santiago , Briceno-Medina Mario , Chan Titus , Diddle J. Wesley , Domnina Yuliya , Clarke-Myers Katherine , Connelly Chloe , Florez Amy , Gaies Michael , Garza Janie , Ghassemzadeh Rod , Lane John , McCammond Amy N. , Olive Mary K. , Ortmann Laura , Prodhan Parthak , Raymond Tia Tortoriello , Sasaki Jun , Scahill Carly , Schroeder Luke W. , Schumacher Kurt R. , Werho David K. , Zhang Wenying , Alten Jeffrey ,   PC4 CAP Collaborators, Jones Megan A. , Miller Benjamin , Wellman Katherine , Benscoter Alexis , Cooper David S. , Wooton Sharyl , Moellinger Ashley , Scalici McAtee Maria , Zaccagni Hayden , Kane Janie , Roper Stephanie , Bradley Brittany , Dick Ashley , Bhakta Rupal T , Das Ashima , Shah Tejas , Burton Grant , Clay Mark , Centers Gabriela , Wong Rudy , Absi Mohammed , Grandberry Michelle H. , Klugman Darren , Riley Christine M. , Fortkiewicz Justine M. , Hom Lisa A. , Parikh Kinjal , Almasarweh Saleem , Abdul Kayoum Anas , Koch Josh , Richardson Amanda , Wellnitz Chasity , Delgado-Corcoran Claudia , Hardin-Reynolds Trudy , Do Thomas B , Schalke Amy J. , McMorrow Sciuto Siobhán , Daley Sean , Wolovits Joshua S. , Yu Priscilla , Gerstmann Julia , Mannan Terri , Buckley Jason R. , Tabbutt Sarah , Chan Titus , Davis Arianna , Hammel James , Burgert Alyss , Norton Bridget , Molitor-Kirsch Erica , Affolter Jeremy T , Miller-Smith Laura , Tieves Kelly S. , Walz Kayla , Rosenberg Colleen , Owens Gabe E. , Mikesell Katherine , Wald Eric , Clark Jade , DiMaria Kimberly , Wilkes Ryan , Steadman Page , Davis Amanda L. , Smith Amanda , Lasa Javier J. , Zahn-Schafer Rebecca , Maynord Patrick , Harold Smith Andrew , Mastropietro Christopher W. , Broo Monica , Vinson Erica , Kluck Jane , Baust Tracy , Graham Tara , Gretchen Catherine , Moga Michael-Alice 
Published: September 2024

Importance

The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined.

Objective

To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement.

Design, Setting, and Participants

This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP–participating hospitals.

Intervention

The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work.

Main Outcomes and Measures

Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed.

Results

There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, −0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up.

Conclusions and Relevance

In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.