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Abstract

Introduction: A Rapid Response Team can be associated with a significant reduction in cardiopulmonary arrest (CPA) outside of pediatric intensive care unit settings, and the resultant decrease in CPA events provides less resuscitation experience. Subsequently attractive, is the implementation of resuscitation training, that includes in-situ simulation, which has been shown to improve code team performance; however, little evidence associates simulation with improved patient outcomes. Hypothesis: We hypothesize that Resuscitation Team Training, including in-situ simulation, is associated with improved post-CPA survival to discharge, decreased accrual of neurological morbidity, and improved code team adherence to American Heart Association (AHA) gold standards of resuscitation. Methods: A prospective observational study with historical controls at a 328-bed academic children’s hospital was conducted. Included in the analysis were all CPA events to which the code team responded during the control and post intervention periods. A total of 183 CPA events in 123 patients were evaluated pre-intervention and 65 CPA events in 46 patients were evaluated post intervention. Code responders were introduced to a Composite Resuscitation Team Training and these educational endeavors were integrated via in-situ mock codes (n=16), designed to generate a realistic code team response. All simulations were videotaped and immediatly debriefed. Results: Patients in the post -intervention group were significantly more likely to survive than in the control group. The post intervention group had less, but not significantly, accrual of neurologic morbidity. The post intervention code team was significantly more likely than the control group to adhere to SOP (OR 2.14; CI 1.15-3.99). The odds of survival in the post- intervention period was significantly improved following events during which the SOP was adhered to (OR=6.00; 95% CI 1.15-31.23). Conclusions: This Composite Resuscitation Team Training that includes in-situ simulations, can be associated with a significant increase in post -CPA event survival to discharge, without an increase in neurologic morbidity in pediatrics and significantly improve code team performance.