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Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes*

Wolfe, Heather MD1; Zebuhr, Carleen MD2; Topjian, Alexis A. MD, MSCE1; Nishisaki, Akira MD, MSCE1; Niles, Dana E. MS1; Meaney, Peter A. MD, MPH1; Boyle, Lori RN, BSN, CCRN1; Giordano, Rita T. RRT-NPS1; Davis, Daniela MD, MSCE1; Priestley, Margaret MD1; Apkon, Michael MD1; Berg, Robert A. MD1; Nadkarni, Vinay M. MD, MS1; Sutton, Robert M. MD, MSCE1

doi: 10.1097/CCM.0000000000000327
Clinical Investigations

Objective: In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events.

Design, Setting, and Patients: Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU.

Interventions: Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers.

Measurements and Main Results: Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed “excellent cardiopulmonary resuscitation,” prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91–6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01–7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9–10.6; p < 0.01).

Conclusion: Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome.

1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA.

2Department of Pediatrics, Section of Critical Care Medicine, Children’s Hospital Colorado, Aurora, CO.

* See also p. 1740.

Unrestricted grant supported, in part, by the Laerdal Foundation for Acute Care Medicine and the Endowed Chair of Pediatric Critical Care Medicine at the Children’s Hospital of Philadelphia.

Dr. Zebuhr received grant support from the Laerdal Foundation (received travel grant from the Laerdal foundation as part of the study development). Dr. Topjian is employed by UPENN and received support for article research from the National Institutes of Health (NIH). She is supported by NIH career development awards (National Institute of Neurological Disorders and Stroke—K23NS075363). Her institution received grant support from the NIH/National Institute of Neurological Disorders and Stroke. Dr. Nishisaki’s institution received grant support from the Laerdal Foundation Center for Excellence. Dr. Niles’ institution received grant support from Laerdal Foundation for Acute Medicine. Dr. Sutton received NIH career development awards (Eunice Kennedy Shriver National Institute of Child Health & Human Development—K23HD062629) and received support for article research from the NIH. His institution received grant support from the NIH (K23 award). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: wolfeh@email.chop.edu

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins