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Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Improved Cardiopulmonary Resuscitation Performance With CODE ACES2: A Resuscitation Quality Bundle
Elizabeth A Hunt1,2,3,4,5, Justin Jeffers2,6, LeAnn McNamara7
11 Department of Anesthesiology and Critical Care Medicine Johns Hopkins Hospital Baltimore MD.
Insights
Implementing the CODE ACES² quality bundle significantly improved chest compression compliance during pediatric in-hospital cardiac arrest. This resuscitation quality bundle enhanced adherence to American Heart Association guidelines, potentially saving lives.
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.
Abstract:
Background Over 6000 children have an in-hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives. Methods and Results A prospective observational study of quality of chest compressions ( CC ) during pediatric in-hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality CC , 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association ( AHA ) Pediatric Advanced Life Support CC guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had CC data captured via defibrillator-based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123], P<0.001). There were 2135 1-minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061, P<0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES2). The adjusted marginal probability of a CC epoch meeting the criteria for excellent CPR (compliant for rate, depth, and chest compression fraction) in 2015, after CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3-53.3) versus 19.9%(6.9-32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3-8.1], P=0.01). Conclusions CODE ACES2 was associated with progressively increased compliance with AHA CPR guidelines during in-hospital cardiac arrest.
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