Abstract 181: In-hospital Cardiac Arrest Debrief In A Pediatric Intensive Care Unit

Abstract

Background: Debrief of in-hospital cardiac arrests (IHCA) has been shown to improve outcomes. There can be limited data available to quantitatively review a resuscitation, but careful analysis can provide insight for improvement. Methods: A standard process for debriefing all cardiac arrests was developed in our institution’s pediatric intensive care unit (PICU). Characteristics of the event were documented, and each arrest was independently reviewed by a lead arrest review investigator including telemetry data, chart review, and provider interviews when available. Data was stored in a secure redcap database. Results: From April 1, 2021 to March 31, 2022 there were n=25 IHCAs in 22 patients. Eighteen (72%) were classified as severe bradycardia with hypotension and/or poor perfusion; 6 (24%) were pulseless electrical activity; and 1 was unstable VT/VF. Two patients had a shockable rhythm during their arrest. The median arrest duration was 6 minutes with the longest duration being 104 minutes. Out of the 25 arrests, 18 (72%) had return of spontaneous circulation. Out of the 22 patients who had at least 1 arrest, 9 (41%) survived to hospital discharge and 12 (55%) died; 1 patient is still admitted. In addition to outcomes data, the debrief process led to many process improvements including the utility of a backboard (Figure 1A) and use of the respiratory rate tracing (thoracic impedance) in assessing compressions (Figure 1B). Discussion: IHCA in pediatric patients confers a significant risk of mortality and morbidity. Development of a comprehensive debrief process will help to identify areas for improvement in all facets of arrest care.