Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes* : Critical Care Medicine

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Clinical Investigations

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

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Critical Care Medicine 42(7):p 1688-1695, July 2014. | DOI: 10.1097/CCM.0000000000000327



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.


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).


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

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

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