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Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action
Jessica A Barreto1, Jesse Wenger2, Maya Dewan3
1From the Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Boston, Ma.
Insights
Pediatric Post-Cardiac Arrest Care (PCAC) delivery varies widely across institutions, with many lacking standardized processes despite national guidelines. Barriers include limited time and training opportunities for effective implementation.
Area of Science:
- Pediatric Critical Care Medicine
- Resuscitation Science
- Quality Improvement in Healthcare
Background:
- National guidelines exist for pediatric post-cardiac arrest care (PCAC) to enhance neurological outcomes and survival.
- Limited research describes the actual delivery of PCAC in pediatric healthcare settings.
- This study investigates PCAC practices within a resuscitation quality collaborative.
Purpose of the Study:
- To describe the current delivery of pediatric post-cardiac arrest care (PCAC) in participating institutions.
- To identify variations and common practices in PCAC implementation.
- To understand barriers to effective PCAC delivery.
Main Methods:
- An electronic REDCap survey was distributed to lead resuscitation investigators in the Pediatric Resuscitation Quality Improvement Collaborative.
- Data collected from participating centers were analyzed using descriptive statistics.
- A chi-square test was employed to compare categorical data between institutions.
Main Results:
- 51% of surveyed centers (24/47) responded, with most from large pediatric intensive care units.
- 67% of centers lacked a specific process for initiating PCAC; only 25% had adherence evaluation mechanisms.
- Common PCAC targets included temperature, blood pressure, and glucose; EEG was frequent, but neuroimaging less so.
Conclusions:
- Significant variation exists in pediatric post-cardiac arrest care (PCAC) delivery among institutions.
- Current PCAC practices do not fully align with national guidelines for standardization.
- Lack of time and training are key barriers to effective PCAC implementation.
Background:
Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative.
Methods:
An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data.
Results:
Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities.
Conclusions:
There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.
