Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes*.
OBJECTIVE
In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events.


METHODS
Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU.


METHODS
Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers.


RESULTS
Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed "excellent cardiopulmonary resuscitation," prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91-6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01-7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9-10.6; p < 0.01).


CONCLUSIONS
Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome.
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Pediatrics, Section of Critical Care Medicine, Children's Hospital Colorado, Aurora, CO.
Heather
H
Wolfe
Carleen
C
Zebuhr
Alexis A
AA
Topjian
Akira
A
Nishisaki
Dana E
DE
Niles
Peter A
PA
Meaney
Lori
L
Boyle
Rita T
RT
Giordano
Daniela
D
Davis
Margaret
M
Priestley
Michael
M
Apkon
Robert A
RA
Berg
Vinay M
VM
Nadkarni
Robert M
RM
Sutton
D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D007318:Inservice Training; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010564:Personnel, Hospital / Q000193:education*; D011446:Prospective Studies; D058996:Quality Improvement; D012138:Respiratory Therapy