Personnel and unit factors impacting outcome after cardiac arrest in a dedicated pediatric cardiac intensive care unit*

Gaies, Michael; Clarke, Nicholas S.; Donohue, Janet E.; Gurney, James G.; Charpie, John R.; Hirsch, Jennifer C.

doi:10.1097/pcc.0b013e318238b272

Cited by 51 publications

(37 citation statements)

References 21 publications

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“…They defined a "failure to rescue" rate as the ability to prevent a clinically important deterioration (ie, death or permanent disability) from a complication. 16 Review of cardiac surgical data at our institution demonstrates that our overall incidence of cardiopulmonary arrests is similar to the incidences reported in other published data series 3,4,17 at 3% to 6% per year. The Get With The Guidelines-Resuscitation database www.ajcconline.org report 13 from 2011 reported a subgroup of cardiac surgical patients with a survival to discharge of 37%, which was similar to our experience in 2010 and 2011.…”

Section: Discussionsupporting

confidence: 66%

“…Over time, our survival rate after cardiopulmonary arrest has improved each year with survival to discharge reaching 55% in 2012 and 81% in 2013, exceeding reported survival rates of 37% to 48% in this specific population. 13,17 This survival rate would suggest that our heart center has lowered our failure-to-rescue rate specifically related to cardiopulmonary arrests in the cardiac surgical patients. Additionally, we have noticed a downward trend, which is not yet significant, in the percentage of cardiopulmonary arrests deemed "potentially preventable."…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary Review of Code Events in a Heart Center

Blankenship

Fernandez

Joy

et al. 2016

American Journal of Critical Care

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Objective To identify a cause for clinical deterioration, examine resuscitation efforts, and identify and correct system issues (thus improving outcomes) via a multidisciplinary code-review process soon after cardiopulmonary arrest. Methods Retrospective analysis of code events in a tertiary pediatric heart center from September 2010 to December 2013 and review of surgical-cardiac data from January 2010 to December 2013. Results A multidisciplinary team reviewed 47 code events, 16 of which (34%) were deemed potentially preventable. At least 2 issues were identified during 66% (31/47) of cardiopulmonary arrests reviewed. Key issues identified were related to communication (62%), environment/ culture/policy (47%), patient care (including resuscitation, 41%), and equipment (38%). About 60% of reviewed arrests resulted in educational initiatives (eg, mock code, in-service education) and 47% resulted in a new policy or modification of existing policy. Less common were changes in equipment (32%) or modification of staffing needs (11%). Changes most frequently occurred in the unit specific to the event (68%) but some changes occurred throughout the Heart Center (32%) or across the hospital system (13%). Survival to discharge after cardiopulmonary arrest has improved over time (P = .03) to 81% for cardiac surgical patients in our center. Conclusion A multidisciplinary code-review committee can identify deficiencies and lead to educational initiatives and improvements in care. When coupled with a hospitalwide "code blue" review process, these changes may benefit the institution as a whole.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Review of Code Events in a Heart Center

Blankenship

Fernandez

Joy

et al. 2016

American Journal of Critical Care

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“…This result is different from a recent study [8] which reported that less experience of the primary nurse caring for a patient, and weekend timing of an arrest event may increase the likelihood of failure to resuscitate cardiac arrest in a dedicated pediatric cardiac ICU [8]. Other reports also suggest that nurses are greater experience are more likely to provide rapid diagnosis of cardiac arrest and pre-arrest intervention to prevent arrest in pediatric patients [11][12][13][14].…”

Section: Discussionmentioning

confidence: 61%

“…Investigations focused on system factors of pediatric cardiac arrest are scarce [8][9][10]. We assessed the impact of system factors (timing and date of cardiac arrest, nursing experience, staffing of the unit) and modifiable intensive care unit (ICU) interventions (sedation, analgesia, central venous access) on outcome from cardiac arrest in a Pediatric intensive care unit.…”

mentioning

confidence: 99%

Impact of system factors and modifiable ICU interventions on the outcome of cardio-pulmonary resuscitation in PICU

et al. 2015

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Objectives:To assess the impact of system factors and modifiable interventions on outcome of cardiac arrest in a pediatric intensive care unit. Design:Retrospective medical record review.Setting: Pediatric intensive care unit of a hospital in China.Participants: Children (age<14 yrs) who had cardiac arrest within our PICU over a period of two years.Results: Sixty-one of the 94 cardiac arrest events were successfully resuscitated. There was no significant association between personal and unit factors with immediate outcomes in our unit. The rate of unsuccessful resuscitation in sedated patients and those without sedation was 26% and 50%, respectively. Unsuccessful resuscitation occurred in 19% of patients who were on positive pressure ventilation as compared with 74% for those without positive pressure ventilation. Arrests which had resuscitation attempts that lasted more than 30 min had 135-fold higher odds of unsuccessful outcome. 78% of patients who received base supplement at the time of arrest had unsuccessful resuscitation compared with 21% for those without base supplement. Conclusions:Our data shows no impact of system factors on the outcome of cardio-pulmonary resuscitation in our PICU. Prearrest sedation in pediatric critical ill patients might be beneficial to the outcome of cardiac arrests.

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“…But it has also been shown that the outcome of cardiac arrest at the PICU, independent of the underlying cause of cardiac arrest, relies on many other variables. Among these are experience of nursing staff, arrest procedures at weekends, and PICU unit-specific factors (4). As a cardiac arrest procedure is mainly a team effort, the quality of the CPR *See also p. 1688. team performance might also be an important factor.…”

mentioning

confidence: 99%