Introduction: The degree of variability in pediatric in-hospital cardiac arrest (IHCA) management across institutions is unknown. The Pediatric Quality of Resuscitation collaborative (pediRES-Q), a multi-center group of hospitals collecting data characterizing resuscitation care, was created to better understand in-hospital pediatric resuscitation systems of care.
Objective: To characterize the variability of CPR, (pre, during and post) IHCA management and performance across a large network of pediatric hospitals.
Methods: Utilizing a prospective, observational cohort, we analyzed data from pediatric IHCAs. Data included hospital characteristics, duration of CPR, and chest compression (CC) performance metrics (CC depth, rate and fraction). We also collected details of site participation in components of a resuscitation QI bundle: high-risk identification checklist, bedside pre-IHCA refreshers, post-IHCA hot and cold debriefings, and a post-IHCA preparation checklist.
Results: 135 IHCA events from Oct 2015 to April 2017 were analyzed from 12 participating pediatric ICUs: median 26 beds (IQR 19, 33), median 1750 admissions/year (IQR 1412, 2327), 75% (9/12) with pediatric critical care fellowship, median IHCA/year 23 (IQR 20, 29). Marked variability between sites was noted for proportion of IHCAs in which event average CPR perormance data was compliant with 2015 AHA guidelines: CC rate (0-100%), CC depth (43 to 100%), and CC fraction (0 to 100%). Participation in components of the resuscitation QI bundle for IHCAs varied by site (Figure): 41% (IQR 0, 59) of IHCA were identified beforehand via high risk checklist; 12% (IQR 0, 26) were preceded by recent staff bedside CPR refreshers; 59% (IQR 16, 86) had post-IHCA hot debriefing and 38% (IQR 9, 100) had post-IHCA cold debriefing.
Conclusions: Striking variability in elements of pediatric cardiac arrest resuscitation management and performance pre-, during and post-IHCA, exist across pediatric ICUs.