Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Sutton, Robert M.; Wolfe, Heather; Reeder, Ron; Ahmed, Tageldin; Bishop, Robert; Bochkoris, Matthew; Burns, Candice; Diddle, J. Wesley; Federman, Myke; Fernandez, Richard; Franzon, Deborah; Frazier, Aisha H.; Friess, Stuart H.; Graham, Kathryn; Hehir, David A.; Horvat, Christopher M.; Huard, Leanna L; Landis, William; Maa, Tensing; Manga, Arushi; Morgan, Ryan W.; Naim, Maryam Y.; Palmer, Chella A.; Schneiter, Carleen; Sharron, Matthew; Siems, Ashley; Srivastava, Neeraj; Tabbutt, Sarah; Tilford, Bradley; Viteri, Shirley; Berg, Robert A.; Bell, Michael J.; Carcillo, Joseph A.; Carpenter, Todd; Dean, Jonathan; Fink, Ericka L.; Hall, Mark W.; McQuillen, Patrick S.; Meert, Kathleen L.; Mourani, Peter M.; Notterman, Daniel A.; Pollack, Murray M.; Sapru, Anil; Wessel, David; Yates, Andrew R.; Zuppa, Athena F.

doi:10.1001/jama.2022.1738

Cited by 42 publications

(41 citation statements)

References 44 publications

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“…The ICU-RESUS study was a multicenter, parallel, hybrid stepped-wedge cluster-randomized trial evaluating a two-part quality improvement bundle of physiology-directed point-of-care training and structured postresuscitation event debriefing compared with usual care ( 12 , 13 ). It was conducted in 18 pediatric and pediatric cardiac ICUs at 10 clinical sites in the United States.…”

Section: Methodsmentioning

confidence: 99%

“…These waveforms were reviewed and analyzed by blinded investigators (R.W.M., R.M.S.) at the Children’s Hospital of Philadelphia as previously described ( 13 , 16 , 17 ).…”

Section: Methodsmentioning

confidence: 99%

“…The association between these widespread resuscitation system changes and pediatric IHCA outcomes and CPR quality during the COVID-19 pandemic is unknown. To address this knowledge gap, we performed a secondary retrospective analysis of data leveraged from a prospective, multicenter, cluster-randomized interventional trial (The ICU-RESUScitation Project [ICU-RESUS]; NCT02837497) ( 12 , 13 ). Our objective was to compare pediatric IHCA outcomes and CPR quality metrics in the first year of the COVID-19 pandemic to the year prior to the pandemic.…”

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confidence: 99%

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The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes*

Morgan

Wolfe

Reeder³

et al. 2022

Pediatric Critical Care Medicine

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Objectives: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes. Design: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021). Setting: Data source was the ICU-RESUScitation Project (“ICU-RESUS;” NCT028374497), a prospective, multicenter, cluster randomized interventional trial. Patients: Children (≤ 18 yr) who received cardiopulmonary resuscitation while admitted to the ICU and were enrolled in ICU-RESUS. Interventions: None. Measurements and Main Results: Among 429 IHCAs meeting inclusion criteria, occurrence during the pandemic period was associated with higher frequency of hypotension as the immediate cause of arrest. Cardiac arrest physiology, cardiopulmonary resuscitation quality metrics, and postarrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1–3 or unchanged from baseline) occurred in 102 of 195 subjects (52%) during the pandemic compared with 140 of 234 (60%) pre pandemic ( p = 0.12). Among survivors, occurrence of IHCA during the pandemic period was associated with a greater increase in Functional Status Scale (FSS) (i.e., worsening) from baseline (1 [0–3] vs 0 [0–2]; p = 0.01). After adjustment for confounders, IHCA survival during the pandemic period was associated with a greater increase in FSS from baseline (+1.19 [95% CI, 0.35–2.04] FSS points; p = 0.006) and higher odds of a new FSS-defined morbidity (adjusted odds ratio, 1.88 [95% CI, 1.03–3.46]; p = 0.04). Conclusions: Using the ICU-RESUS dataset, we found that relative to the year prior, pediatric IHCA during the first year of the COVID-19 pandemic was associated with greater worsening of functional status and higher odds of new functional morbidity among survivors.

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Section: Methodsmentioning

confidence: 99%

“…These waveforms were reviewed and analyzed by blinded investigators (R.W.M., R.M.S.) at the Children’s Hospital of Philadelphia as previously described ( 13 , 16 , 17 ).…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes*

Morgan

Wolfe

Reeder³

et al. 2022

Pediatric Critical Care Medicine

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“…To the Editor We have some concerns about a recent trial that demonstrated that a bundled intervention of CPR training and postcardiac arrest debriefings did not improve patient survival to hospital discharge with favorable neurologic outcome among pediatric patients with cardiac arrest.…”

mentioning

confidence: 87%

Point-of-Care Cardiopulmonary Resuscitation Training and Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Liu

Tu²,

Chen

2022

JAMA

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“…The Improving Outcomes from Paediatric Cardiac Arrest—the ICU-Resuscitation Project, was a parallel, hybrid stepped-wedge, cluster randomised trial, involving 18 paediatric intensive care units (ICUs) from 10 North American hospitals [ 36 ]. The intervention comprised an ICU resuscitation quality improvement bundle consisting of (1) CPR training at the point of care on a manikin and (2) structured debriefings of cardiac arrest events focusing on physiological outcomes.…”

Section: Adrenalinementioning

confidence: 99%

Improving vasopressor use in cardiac arrest

Perkins

Couper

2023

Crit Care

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The Chain of Survival highlights the effectiveness of early recognition of cardiac arrest and call for help, early cardiopulmonary resuscitation and early defibrillation. Most patients, however, remain in cardiac arrest despite these interventions. Drug treatments, particularly the use of vasopressors, have been included in resuscitation algorithms since their inception. This narrative review describes the current evidence base for vasopressors and reports that adrenaline (1 mg) is highly effective at achieving return of spontaneous circulation (number needed to treat 4) but is less effective on long-term outcomes (survival to 30 days, number needed to treat 111) with uncertain effects on survival with a favourable neurological outcome. Randomised trials evaluating vasopressin, either as an alternative to or in addition to adrenaline, and high-dose adrenaline have failed to find evidence of improved long-term outcomes. There is a need for future trials to evaluate the interaction between steroids and vasopressin. Evidence for other vasopressors (e.g. noradrenaline, phenylephedrine) is insufficient to support or refute their use. The use of intravenous calcium chloride as a routine intervention in out of hospital cardiac arrest is not associated with benefit and may cause harm. The optimal route for vascular access between peripheral intravenous versus intraosseous routes is currently the subject of two large randomised trials. Intracardiac, endobronchial, and intramuscular routes are not recommended. Central venous administration should be limited to patients where an existing central venous catheter is in situ and patent.

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Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Cited by 42 publications

References 44 publications

The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes*

The Temporal Association of the COVID-19 Pandemic and Pediatric Cardiopulmonary Resuscitation Quality and Outcomes*

Point-of-Care Cardiopulmonary Resuscitation Training and Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Improving vasopressor use in cardiac arrest

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