Improving paediatric cardiac arrest outcomes: cpr quality improvement collaborative (CPR-QUIC)

Abstract

Introduction: Cardiopulmonary Resuscitation (CPR) guidelines recommend target values for selected CPR parameters related to rate and depth of chest compressions. International experts in resuscitation science have incorporated real-time CPR feedback into clinical practice and have demonstrated improved functional outcomes after cardiac arrest. Recent technological developments using accelerometer-based measurements incorporated into defibrillator systems, allow for real-time monitoring and feedback of CPR quality during resuscitation attempts. Aims: To improve the quality of CPR delivered to cardiac arrest patients in a paediatric intensive care unit (PICU) using defibrillators with real-time CPR feedback. To determine the association between quantitative CPR measures and patient outcomes after cardiac arrest. Methods: A bedside resuscitation training program was designed for the implementation of real-time CPR feedback devices. Medical and nursing staff were taught to interpret CPR metrics (depth and rate) on task trainers and CPR quality feedback training was incorporated into simulation-based education. Real-time CPR feedback technology was implemented in February 2019 and quantitative chest compression data was collected on all cardiac arrests in PICU. The data from each CPR event, metrics and time to defibrillation, was analysed. The arrest event data was reported to an international study collaborative to help determine the association between chest compression mechanics and patient outcomes. Results: Real-time CPR feedback used during resuscitation training improved staff performance. Since implementation, real-time CPR feedback was used in four arrest events and all patients survived to discharge from intensive care. The implementation of the project led to the standardisation of resuscitation training, cardiac arrest management and facilitated local process change within the PICU. Conclusion: We were the first institution in Australia to report paediatric cardiac arrest data for international benchmarking to improve patient outcomes after cardiac arrest. The CPR data collected provided objective feedback to resuscitation teams and guided training in order to improve performance.