Improved Cardiopulmonary Resuscitation Performance With CODE ACES²: A Resuscitation Quality Bundle

Area of Science:

• Pediatric Critical Care Medicine
• Resuscitation Science
• Quality Improvement in Healthcare

Background:

• Over 6000 children experience in-hospital cardiac arrest annually in the US, with low survival rates.
• Variability in survival across hospitals suggests room for improvement in resuscitation performance.
• High-quality chest compressions are crucial for improving outcomes in pediatric cardiac arrest.

Purpose of the Study:

• To implement a debriefing program and identify barriers to high-quality chest compressions.
• To develop and implement a resuscitation quality bundle (CODE ACES²).
• To measure the impact of the CODE ACES² bundle on compliance with American Heart Association Pediatric Advanced Life Support guidelines.

Main Methods:

• Prospective observational study of chest compression quality during pediatric in-hospital cardiac arrest.
• Development and implementation of the CODE ACES² (CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation) bundle.
• Analysis of 2135 one-minute cardiopulmonary resuscitation epochs using logistic regression to assess compliance over time.

Main Results:

• Chest compression data capture increased from 13% in 2013 to 51% in 2015.
• The CODE ACES² bundle was associated with a significant increase in excellent CPR compliance (44.3% in 2015 vs. 19.9% in 2013).
• Compliance with American Heart Association CPR guidelines improved progressively after CODE ACES² implementation (OR 3.2, P=0.01).

Conclusions:

• The CODE ACES² resuscitation quality bundle is associated with improved chest compression quality in pediatric in-hospital cardiac arrest.
• Enhanced adherence to CPR guidelines through CODE ACES² may lead to better patient outcomes.
• Quality improvement initiatives like CODE ACES² are vital for advancing pediatric resuscitation care.