Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Department of Anaesthesia, Harvard Medical School, Boston, MA.
Department of Paediatric Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Crit Care Med. 2020 Jul;48(7):e542-e549. doi: 10.1097/CCM.0000000000004349.
To evaluate the effectiveness of a quality-improvement initiative in reducing cardiac arrests in infants and children in the cardiac ICU.
Prospective observational before-after cohort study.
Single pediatric cardiac ICU in the United Kingdom.
All patients less than 18 years old admitted to the ICU.
Initial interdisciplinary training in cardiac arrest prevention followed by clinical practice change whereby patients with high-risk myocardium were identified on daily rounds. High-risk patients had bolus epinephrine preordered and prepared for immediate administration in the event of acute hypotension.
Interrupted time series analysis was used to compare the cardiac arrest rate in the 18 months before and 4.5 years after implementation. Mean monthly cardiac arrest rate was 17.2 per 1,000 patient days before and 7.6 per 1,000 patient days after the initiative (56% decrease). Patient characteristics and ICU interventions were similar in the control and intervention periods. In the time series analysis, monthly cardiac arrest rate in the ICU decreased by 12.4 per 1,000 patient days (95% CI, -1.5 to -23.3; p = 0.03) immediately following the intervention, followed by a nonsignificant downward trend of 0.36 per 1,000 patient days per month (95% CI, -1.3 to 0.6; p = 0.44). Bolus epinephrine was administered during 110 hypotension events in 77 patients (eight administrations per 1,000 ICU days); responder rate was 77%. There were no significant changes in ICU and hospital mortality.
Implementation of the initiative led to a significant, sustained reduction in ICU cardiac arrest rate.
评估一项质量改进计划在减少儿童心脏重症监护病房（CICU）中婴儿和儿童心脏骤停的效果。
前瞻性观察前后队列研究。
英国一家儿科心脏重症监护病房。
所有年龄小于 18 岁入住 ICU 的患者。
最初进行心脏骤停预防的跨学科培训，然后进行临床实践改变，即在日常查房中确定具有高危心肌的患者。高危患者的肾上腺素推注医嘱预先开好处方，并准备好在出现急性低血压时立即给药。
采用中断时间序列分析比较实施前 18 个月和实施后 4.5 年期间的心脏骤停率。实施前平均每月心脏骤停率为每 1000 个患者日 17.2 例，实施后为每 1000 个患者日 7.6 例（减少 56%）。在对照和干预期间，患者特征和 ICU 干预措施相似。在时间序列分析中，ICU 每月心脏骤停率立即下降 12.4 例/每 1000 个患者日（95%CI，-1.5 至-23.3；p=0.03），随后每月呈非显著下降趋势，为 0.36 例/每 1000 个患者日（95%CI，-1.3 至 0.6；p=0.44）。在 77 名患者的 110 次低血压事件中给予了肾上腺素推注（每 1000 ICU 天 8 次给药）；反应率为 77%。ICU 和医院死亡率无显著变化。
该计划的实施导致 ICU 心脏骤停率显著且持续降低。
