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In-hospital pediatric cardiac arrest: Improving survival rates

More than 200,000 pediatric in-hospital cardiac arrests occur each year in the United States. According to the American Heart Association, children suffering in-hospital cardiac arrest are three times more likely to survive than they were a decade ago.

Even though the figures have improved over the past 10 years, more than 60% of these patients will suffer severe neurologic disability or will not make it out of the hospital alive.

With this in mind, a research team out of The Children’s Hospital of Philadelphia (CHOP) decided to study whether an ER team debriefing after providing emergency care for pediatric cardiac arrest patients would improve their CPR performance and increase the rates of patients surviving with favorable neurological outcomes.

The study looked at pediatric patients who received chest compressions in the ICU at CHOP between December 2008 and June 2012. Following implementation of a post-arrest debriefing program, they compared a control group, which included patients up to June 2010, to an intervention group, which included patients who received CPR between December 2010 and June 2012.

They found that survival with favorable neurological outcome increased from 29% to 50% among the intervention group.

"The team debriefings were associated with a near-doubling of good neurological survival for children who suffer a cardiac arrest in our ICU," said lead author Heather Wolfe, MD, a critical care physician at The Children's Hospital of Philadelphia, who added, "Our unique, interdisciplinary debriefing program resulted in improvements of CPR technique to levels of American Heart Association (AHA) Guideline compliance previously not thought possible – this was truly a stellar achievement."

The CHOP research team said the findings suggest that including all members of the ICU team, not just the members directly involved with the patient, broadens learning and may improve CPR performance.

"Bringing together all members of the multidisciplinary team for a post-event debrief better prepares everyone who could come in future contact with a patient in sudden cardiac arrest," said Wolfe.

At CHOP, all ICU physicians, respiratory therapists, and nurses are certified in pediatric advanced life support and/or advanced cardiovascular life support and participate in frequent mock code and rolling refresher CPR training.

"This study demonstrates how doctors, nurses, and other healthcare providers can come together to improve in-hospital care and save lives," said Robert Sutton, MD, MSCE, chair of the hospital's Resuscitation Committee and senior author on the project.

"This is the first study in children showing that pre-training with simulation and debriefing teams on how we can do it better improves survival. It also highlights what a unique program we have here for cardiac arrest patients from prevention, care during arrest, and post-arrest care," said Robert Berg, MD, chief of critical care medicine at The Children's Hospital of Philadelphia.