Cardiac arrest in the paediatric intensive care unit: defining the problem and developing solutions.
Abstract
Thousands of children experience a cardiac arrest event in the hospital each year,
with more than half of these patients not surviving to hospital discharge. Cardiopulmonary
resuscitation (CPR) depth, rate, velocity and percentage of high-quality chest compressions
are modifiable factors associated with improved survival. Therefore, we created a
novel and standardised process to track and analyse cardiac arrests in the Duke paediatric
intensive care unit (PICU). Our aim was to identify areas for improved American Heart
Association (AHA) compliance and implement education and communication-based initiatives
to enhance early recognition of at-risk patients leading to improved outcomes. From
January 2017 to December 2018, all cardiac arrests in our PICU were tracked, reviewed
and presented at monthly morbidity and mortality conference. We used the data to track
compliance with AHA guidelines and identify opportunities for improvement. Through
these efforts, we established a multidisciplinary cardiac arrest education and review
programme. Over the 2-year period, we tracked 45 cardiac arrests, which comprised
2% of all PICU admissions. In 2017, during the first year of development, 16 of 22
arrests (73%) were not reported to code committee members in time for complete review.
Of the six cardiac arrests with complete reviews, only 17% followed AHA guidelines.
In 2018, all 23 arrest events were communicated and 76% of resuscitations were found
to be compliant with AHA guidelines. Survival of patients to discharge was 47% in
2017 and increased to 63% in 2018 with similar percentage of PICU admissions having
a cardiac arrest between the 2 years. The primary aim of this project was to establish
a multidisciplinary comprehensive cardiac arrest review process. This programme allowed
for comprehensive analysis of individual events, promoted quality improvement initiatives
and improved consistent delivery of high-quality CPR.
Type
Journal articlePermalink
https://hdl.handle.net/10161/23394Published Version (Please cite this version)
10.1136/bmjoq-2020-000930Publication Info
Ray, Candice M; Pizzuto, Matthew; Reyes-Alvarado, Edith; Jackson, Kimberly; Turner,
David A; & Kamath, Sameer (2020). Cardiac arrest in the paediatric intensive care unit: defining the problem and developing
solutions. BMJ open quality, 9(4). 10.1136/bmjoq-2020-000930. Retrieved from https://hdl.handle.net/10161/23394.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Sameer Shantaram Kamath
Associate Professor of Pediatrics
I love children and everything about them. I believe in caring for each of my patients
as I would my own children. I believe in investing in systems of care and ensuring
that the care we provide is safe, efficient and evidence-based.I am interested in
quality/performance improvement and making systems more efficient.
David Ashley Turner
Adjunct Professor in the Department of Pediatrics
Education Medical Simulation Extracorporeal Support
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info