Pediatric Critical Care, WakeMed Raleigh Campus, Raleigh, North Carolina, USA
Pediatric Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Open Qual. 2020 Dec;9(4). doi: 10.1136/bmjoq-2020-000930.
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.
每年都有数千名儿童在医院发生心脏骤停事件，其中超过一半的患者未能存活至出院。心肺复苏术（CPR）的深度、频率、速度和高质量胸外按压的百分比是与生存率提高相关的可改变因素。因此，我们创建了一种新颖的、标准化的流程，用于跟踪和分析杜克儿童重症监护病房（PICU）的心脏骤停事件。我们的目的是确定提高美国心脏协会（AHA）合规性的领域，并实施基于教育和沟通的举措，以提高对高危患者的早期识别，从而改善预后。从 2017 年 1 月至 2018 年 12 月，我们对 PICU 中的所有心脏骤停事件进行了跟踪、审查，并在每月的发病率和死亡率会议上进行了汇报。我们使用这些数据来跟踪 AHA 指南的遵守情况，并确定改进的机会。通过这些努力，我们建立了一个多学科的心脏骤停教育和审查计划。在 2 年的时间里，我们共跟踪了 45 例心脏骤停事件，占 PICU 总入院人数的 2%。在 2017 年的发展初期，有 22 例心脏骤停事件中的 16 例没有及时报告给代码委员会成员进行全面审查。在接受全面审查的 6 例心脏骤停事件中，只有 17%符合 AHA 指南。在 2018 年，所有 23 例心脏骤停事件都进行了通报，76%的复苏事件符合 AHA 指南。2017 年患者出院存活率为 47%，2018 年增加至 63%，2 年期间 PICU 入院的心脏骤停率相似。该项目的主要目的是建立一个多学科的全面心脏骤停审查流程。该计划允许对个体事件进行全面分析，促进了质量改进举措，并提高了高质量 CPR 的持续实施。
