Pfeiffer Stephen, Zackoff Matthew, Bramble Katelyn, Jacobs Lindsey, Ruehlmann Kristen, Stalets Erika L, Tegtmeyer Ken, Dewan Maya
Department of Pediatrics, Division of Critical Care Medicine, Children's Mercy Hospital, Kansas City, Mo.
The University of Missouri Kansas City School of Medicine, Kansas City, Mo.
Pediatr Qual Saf. 2021 Mar 10;6(2):e392. doi: 10.1097/pq9.0000000000000392. eCollection 2021 Mar-Apr.
Pediatric cardiac arrests carry significant morbidity and mortality. With increasing rates of return of spontaneous circulation, it is vital to optimize recovery conditions to decrease morbidity.
We evaluated all patients who presented to a large quaternary pediatric intensive care unit with return of spontaneous circulation. We compared patient-specific postcardiac arrest care preimplementation and postimplementation of a standardized postcardiac arrest resuscitation pathway. We implemented evidence-based best practices using the Translating Research into Practice framework and Plan-Do-Study-Act cycles. Our primary aim was to increase the percent of postcardiac arrest care events meeting guideline targets for blood pressure and temperature within the first 12 hours by 50% within 18 months.
Eighty-one events occurred in the preintervention group (August 1, 2016-April 30, 2018) and 64 in the postintervention group (May 1, 2018-December 1, 2019). The percent of postcardiac arrest events meeting guideline targets for the entirety of their postarrest period improved from 10.9% for goal mean arterial blood pressure to 26.3%, = 0.03, and increased from 23.4% for temperature to 71.9%, < 0.0001.
Implementing a postcardiac arrest standardized care plan improved adherence to evidence-based postcardiac arrest care metrics, specifically preventing hypotension and hyperthermia. Future multicenter research is needed to link guideline adherence to patient outcomes.
小儿心脏骤停具有显著的发病率和死亡率。随着自主循环恢复率的提高，优化复苏条件以降低发病率至关重要。
我们评估了所有入住大型四级儿科重症监护病房且自主循环恢复的患者。我们比较了标准化心脏骤停后复苏路径实施前后特定患者的心脏骤停后护理情况。我们使用“将研究转化为实践”框架和“计划-执行-研究-行动”循环实施基于证据的最佳实践。我们的主要目标是在18个月内将心脏骤停后护理事件在最初12小时内达到血压和体温指南目标的百分比提高50%。
干预前组（2016年8月1日至2018年4月30日）发生了81起事件，干预后组（2018年5月1日至2019年12月1日）发生了64起事件。心脏骤停后事件在整个骤停后期间达到指南目标的百分比，目标平均动脉血压从10.9%提高到26.3%，P = 0.03，体温从23.4%提高到71.9%，P < 0.0001。
实施心脏骤停后标准化护理计划提高了对基于证据的心脏骤停后护理指标的依从性，特别是预防了低血压和体温过高。未来需要多中心研究将指南依从性与患者结局联系起来。
