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Published on: November 21, 2017
Targeted Temperature Management After Pediatric Cardiac Arrest: A Quality Improvement Program With Multidisciplinary
Mason P McMullin1,2, Noelle B Cadotte3, Erin M Fuchs4
1Department of Pediatrics, Uniformed Services University, Bethesda, MD.
Insights
Implementing a targeted temperature management (TTM) bundle significantly reduced fever duration in pediatric cardiac arrest survivors. This quality improvement initiative improved patient outcomes by minimizing fever time post-cardiac arrest.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Science
- Cardiovascular Research
Background:
- Fever post-cardiac arrest is associated with worse neurological outcomes in pediatric patients.
- Effective fever management is crucial for improving survival and recovery after cardiac arrest.
- Current targeted temperature management (TTM) protocols require optimization for pediatric populations.
Purpose of the Study:
- To implement a comprehensive TTM bundle in a pediatric intensive care unit (PICU).
- To reduce the percentage of time patients experienced fever (temperature > 38°C) after cardiac arrest.
- To achieve a target reduction in febrile time from 7% to 3.5%.
Main Methods:
- A prospective quality improvement initiative was conducted over 16 months (April 2021 to June 2022).
- A TTM bundle including standardized temperature goals, cooling blanket protocols, scheduled antipyretics, and shivering management was implemented.
- Data from 29 pre-intervention historical control patients were compared with 46 intervention period patients.
Main Results:
- The median percentage of febrile time per patient decreased from 7% (IQR, 0-13%) to 0% (IQR, 0-3%) (p < 0.001).
- Fewer patients experienced fever at any time during the intervention period (16/46 vs. 21/29; 37% reduction; p = 0.002).
- No significant association was found between the intervention and the development of hypothermia (< 35°C).
Conclusions:
- Implementation of a TTM bundle effectively reduces fever duration and frequency in pediatric cardiac arrest survivors.
- This quality improvement project demonstrates the successful application of a TTM bundle in a PICU setting.
- The TTM bundle is a valuable strategy for improving post-cardiac arrest care in pediatric patients.
Objectives:
We aimed to implement a post-cardiac arrest targeted temperature management (TTM) bundle to reduce the percent of time with a fever from 7% to 3.5%.
Design:
A prospective, quality improvement (QI) initiative utilizing the Method for Improvement. The pre-intervention historical control period was February 2019 to March 2021, and the intervention test period was April 2021 to June 2022.
Setting:
The PICU of a freestanding, tertiary children's hospital, in the United States.
Patients:
Pediatric patients 2 days old or older to 18 young or younger than years old who experienced cardiac arrest, received greater than or equal to 2 minutes of chest compressions, required invasive mechanical ventilation post-resuscitation, and had no documented limitations of care.
Interventions:
We developed and implemented a TTM bundle that included standard temperature goals, instructions and training on cooling blanket use, scheduled prescription of antipyretics, an algorithm for managing shivering, and standardized orders in our electronic health record.
Measurements And Results:
We reviewed data from 29 patients in the pre-intervention period and studied 46 in the intervention period. In comparison with historical controls, the reduction in median (interquartile range [IQR]) percentage of febrile (> 38°C) time per patient associated with the TTM bundle was 0% (IQR, 0-3%) vs. 7% (IQR, 0-13%; p < 0.001). The intervention period, vs. pre-intervention, was associated with fewer patients with fever at any time (16/46 vs. 21/29; mean reduction, 37%; 95% CI, 13.8-54.8%; p = 0.002). We failed to identify an association between the intervention period, vs. pre-intervention, and the development of hypothermia (< 35°C; 8/46 vs. 3/29; mean change, 7%; 95% CI, -10.9% to 21.8%; p = 0.40).
Conclusions:
In this QI project, we have demonstrated that implementation of a TTM bundle is associated with reduced duration and frequency of fever in patients who survive cardiac arrest.
Related Concept Videos
01:29Decreased Body Temperature
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History: