The Effect of an Interdisciplinary Simulation Training Program on Translational Outcomes for In-Hospital Cardiopulmonary Arrests

Abstract

SESSION TITLE: ICU Management SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 08:45 AM - 10:00 AM PURPOSE: High-quality cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) is the primary component influencing return of circulation (ROSC) and survival to hospital discharge, but few hospitals track these metrics. Small studies have demonstrated significant improvements in survival after IHCA events following implementation of a dedicated code team training program. We developed a Code Team Training (CTT) course for our institution, and evaluated its post-implementation effect on CPR quality and post-IHCA patient outcomes. METHODS: CPR quality data was prospectively collected from actual IHCA events for quality improvement purposes, with 12-months pre-CTT and 11 months post-CTT. Pre-CTT data shaped the elements of the four-hour CTT course that included didactics, small group sessions, and high-fidelity simulation exercises. 111 multi-professional code team members were trained in 10 courses. Data collection included CPR quality and translational outcomes for events where CPR was performed. CodeNet® software was used for CPR quality measures, cardiac rhythm, defibrillation metrics, use of continuous waveform capnography, and pauses in compressions. Key translational outcomes measures included event location, ROSC, and survival to hospital discharge. RESULTS: CPR quality was obtained from 150 of 303 (49.5%) in- and out-of-hospital pulseless adult cardiac arrest events over 23 months (63 [44.4%] before CTT and 87 [54.0%] following the first course). Total CPR time captured was 24 hours, 5 minutes, 32 seconds (146,449 chest compressions). There was no difference between groups in terms of event location within the hospital, initial event rhythm, or the proportion of events transmitted to CodeNet™ via WiFi. Of note, there were significantly more out-of-hospital arrests in the post-CTT group. Median compressions in target depth and rate was 31.9% [IQR 10.2-64.4] before CTT and 75.0% [IQR 53.0-83.4] after CTT (p=0.005). While compression depth remained similar (88.2% pre-CTT and 94.3% post-CTT), mean rate and median rate-in-target improved from 117.49 +/- 16 cpm and 29% pre-CTT to 109.5 +/- 13.8 cpm and 61% post-CTT (p=0.0006). Index in-hospital pulseless cardiac arrest survival rate for our institution improved from 28% to 36% before and after CTT [p-value NS], which far surpasses the national average (23.8%). ROSC also trended towards an improvement from 49% to 58% (p-value NS). Survival for out-of-hospital arrests also improved from 0% to 8% (p-value NS). CONCLUSIONS: After the initiation of a CTT program targeting key code team member personnel, CPR quality significantly improved, which translated into a nonstatistically significant trend towards increased survival for IHCA patients. CLINICAL IMPLICATIONS: IHCA is a relatively infrequent high-stakes event with a low national average for survival to discharge that has not significantly improved over the years even with increased knowledge and technical advances. Preliminary results from our pilot study demonstrate that implementation of a formal CTT program resulted in 10 additional lives saved over a 6-month span compared to pre-intervention standard-of-care. Ongoing research is currently evaluating the long term sustainability and exportability of our CTT program. DISCLOSURE: The following authors have nothing to disclose: John Hunninghake, Heather Delaney, Justin Reis, Matthew Borgman, Raquel Trevino, Renee Matos No Product/Research Disclosure Information