Abstract 180: Impact Of Hot Debriefing Programs On Pediatric Cardiopulmonary Resuscitation Quality And Outcomes

Abstract

Introduction: Successful cardiopulmonary resuscitation (CPR) outcomes rely on AHA guideline compliant chest compressions (CC). Resuscitation teams struggle to achieve these CPR metrics. Cold debriefing has led to higher quality CPR and improved patient outcomes. The impact of hot debriefing (HD) on CPR quality and patient outcomes is unknown. We sought to evaluate the association of HD on CPR quality and patient outcomes. Methods: Retrospective cohort of in-hospital cardiac arrests (IHCA), 0 to 18yo with complete quantitative CC metrics in the pediRES-Q database (1/2018 - 3/2021). We investigated exposure to HD, defined as hospital HD rate >50% in the 12 months prior to the CPR event, with AHA compliant CPR (CC fraction (CCF) ≥0.80, CC rate (CCR) 100-120/min, and CC depth (CCD) <1yo ≥3.4 cm, 1-8yo ≥4.4 cm, >8yo 4.5≥6.6 cm). HD vs. non-HD events by CPR quality were compared via Chi-square or Wilcoxon rank sum tests and stratified by age. For index events, we evaluated return of circulation (ROC), survival to hospital discharge (SHD) and favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1, 2, or no change from baseline). Multivariable logistic regressions with a Generalized Estimating Equation method, adjusted for age group, arrest duration, initial rhythm, illness category, and site clustering. Results: We evaluated 515 IHCA events stratified by HD exposure (221 w and 294 wo) and age. Across age ranges, there was no difference in CCD or CCF between groups. Median CCR was lower in HD exposure groups: <1yo, 110 vs 117 (p <0.001), 1-8yo, 110 vs 117 (p <0.001) and 8-<18yo, 110 vs 115 (p =0.003). There was no difference in compliance with a composite of CCF + CCR + CCD. The composite CCR + CCF had increased compliance in the HD exposure groups: <1yo, 37% (34 of 92) vs 21% (21 of 102) (p = 0.02), 1-8yo, 38% (27 of 72) vs 23% (26 of 111) (p = 0.05) and 8-<18yo, 42% (24 of 57) vs 25% (20 of 81) (p = 0.04). To assess patient outcomes, we evaluated 917 index arrests (255 w HD exposure and 662 wo). On multivariable analysis, no significant difference was found for ROC, SHD or favorable neurologic outcome by HD exposure. Conclusion: Pediatric IHCA events with HD exposure demonstrated improved CPR metrics for CCR and CCF. No association was identified for patient level outcomes.