Resuscitation Quality Improvement Research Articles

Analysis of factors affecting in-hospital emergency response capability based on objective assessment

To analyze the factors affecting the quality of cardiopulmonary resuscitation (CPR) performed by medical staff in hospital and to explore the training methods to enhance their in-hospital emergency response capabilities. A cross-sectional study was conducted, involving medical staff of intensive care unit (ICU) and general internal medicine wards in China-Japan Friendship Hospital in December 2021. The American Heart Association (AHA) resuscitation quality improvement (RQI) model was used to evaluate the skills of the subjects in performing external chest compressions and bag-mask ventilation on adult and infant simulators. While ICU subjects were undergoing RQI model objective assessment, two instructors also provided subjective scoring for their operations. The study compared the differences in RQI model objective assessment scores between ICU and general internal medicine ward subjects, between doctors and nurses, in the RQI model objective scoring for adult and infant resuscitation, in the scoring differences of different positions for chest compressions, and the differences between traditional subjective scoring and RQI objective scoring when ICU subjects were assessed for compression and ventilation. A total of 75 medical staffs were enrolled, consisting of 50 from the ICU (including 24 doctors and 26 nurses) and 25 from the general internal medicine wards (including 10 doctors and 15 nurses). The ICU medical staff's scores for adult resuscitation skills were significantly higher than those of the general internal medicine ward medical staff [adult compression score: 82.5 (66.0, 96.5) vs. 65.0 (52.5, 74.5), adult ventilation score: 82.0 (68.8, 98.0) vs. 61.0 (48.0, 82.0), both P < 0.01]. The nursing group's compression scores for both adult and infant were significantly higher than those of the doctor group [adult compression score: 77.0 (68.5, 89.5) vs. 63.0 (40.8, 90.3), infant compression score: 54.4±25.1 vs. 41.5±18.5, both P < 0.05]. The compression and ventilation scores for the infant were significantly lower than those for adult resuscitation [compression score: 48 (29, 65) vs. 76 (58, 90), ventilation score: 56 (42, 75) vs. 76 (60, 96), both P < 0.01]. When the rescuer was positioned on the right side of the model, the compression score for the adult significantly increased [79.0 (65.0, 92.0) vs. 65.0 (51.3, 77.0), P < 0.05]. The ICU medical staff's traditional subjective scores of compression and ventilation assessments for adult were significantly higher than the RQI model objective scores [adult compression score: 88.8 (79.4, 92.5) vs. 82.5 (66.0, 95.5), adult ventilation score: 95.0 (80.0, 98.1) vs. 82.0 (68.8, 98.0), both P < 0.01]. Rich experience in emergency rescue is related to the improvement of CPR skills, and performing chest compressions from the right side of the adult model is more effective. Objective scoring of resuscitation skills based on the RQI model may more accurately reflect the performance of the trainees.

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action.

Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative. An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data. Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities. There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.

Developing competency of nursing students in cardiopulmonary resuscitation using Resuscitation Quality Improvement technology.

This study examined the outcomes of training nursing students in CPR skills using the Resuscitation Quality Improvement (RQI) program. Nursing students (n=2,193) in 12 schools across the United States participated in this study. Students performed compressions and bag-masked ventilation on adult and infant manikins using the RQI simulation station without and then with feedback on their performance. With real-time, objective feedback from the RQI simulation station, students' performance of CPR skills improved, and they retained their skills over time. The RQI program and methodology of feedback is effective for training nursing students to be competent in CPR skills, essential for safe patient care. Nursing and other healthcare professions programs should consider adopting the RQI program for students to develop competency in CPR.

Implementation of the Resuscitation Quality Improvement Program in a System of Hospitals: A Map for Success

Implementation of the Resuscitation Quality Improvement Program in a System of Hospitals: A Map for Success

Survey of resuscitation practices at emergency medical service agencies in the U.S

BackgroundSurvival for out-of-hospital cardiac arrest (OHCA) varies across emergency medical service (EMS) agencies. Yet, little is known about resuscitation response and quality improvement activities at EMS agencies. We describe herein a novel survey to EMS agencies in a U.S. registry for OHCA. MethodsUsing data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 577 EMS agencies with ≥10 OHCA cases annually between 2015 and 2019 that remained active in CARES. We administered a survey to EMS directors regarding agency characteristics, cardiac arrest response, relationships with first responders and dispatchers, quality improvement activities and perceived barriers in the community. ResultsOf eligible EMS agencies, 470 (81.5%) completed the survey. The high completion rate was likely due to frequent personalized emails and phone calls, liaising with CARES state coordinators to encourage survey response, and multiple periodic drawings of an automated external defibrillator during the survey period for participating EMS agencies. The survey examined rates of resuscitation training modalities; use of resuscitation equipment and devices in the field; frequency of simulation; non-EMS stakeholder response to OHCA (dispatchers, fire, police); quality improvement; and community factors affecting bystander response to OHCA. ConclusionsIn this study design paper on the RED-CASO survey, we provide summary data on EMS agency characteristics in the U.S. Upon linkage to CARES patient-level data, this survey will provide critical insights into ‘best practices’ at EMS agencies with the highest OHCA survival rates as well as provide insights into current disparities in outcomes.

Resuscitation Quality Improvement: Improving Clinicians' Performance.

Although cardiopulmonary resuscitation (CPR) renewal occurs every 2 years, quality of performed CPR at the study site was below American Heart Association (AHA) standards. Resuscitation Quality Improvement (RQI) is a new AHA program with the premise that practicing CPR more frequently using audiovisual feedback can improve performance. To identify whether performance of chest compressions during training reassessments improves with RQI. This study used a preintervention-postintervention design. Critical care nurses from 2 intensive care units performed a baseline round of chest compressions. These baseline data reflected CPR performance with traditional training. The next week, participants completed RQI training. Two weeks after RQI training, participants performed chest compressions. Five weeks after RQI training, participants performed a third round of chest compressions. The compressions performed 2 and 5 weeks after RQI used audiovisual feedback. Thirty nurses participated. Before intervention, the mean (SD) for overall compression compliance was 32.68% (26.96%), depth was 67.76% (30.15%), and rate was 39.95% (27.41%). The first postintervention (RQI plus 2 weeks) mean (SD) increased to 75.33% (33.70%) for overall compression compliance, 97.43% (12.04%) for depth, and 80.89% (29.35%) for rate. The second postintervention (RQI plus 5 weeks) mean (SD) decreased slightly to 73.16% (36.36%) for overall compression compliance, 96.57% (13.04%) for depth, and 78.75% (31.83%) for rate. Frequent CPR using RQI technology, with its immediate audiovisual feedback, helps maintain skills, which may improve patient outcomes.

Facilitators and barriers for implementation of a novel resuscitation quality improvement package in public referral hospitals of Nepal

BackgroundImproving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention’s successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal.MethodsThe study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework.ResultsThe findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project’s implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package.ConclusionThe introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably.Trial RegistrationNot applicable.

Epidemiology, risk factors and outcomes associated with in-hospital reflex-mediated cardiac arrest

Aim of the studyOveractivation of the parasympathetic nervous system can lead to reflex syncope (RS) and, in extreme cases, trigger an unusual and underrecognized form of cardiac arrest. We characterized the epidemiology and prognosis of reflex-mediated cardiac arrest (RMCA) and hypothesized it is associated with intervenable patient factors. MethodsThis retrospective case-control study examined RMCAs at two academic hospitals from 1/2016 to 6/2022 using a resuscitation quality improvement database. RMCA cases were identified as cardiac arrests preceded by vagal trigger(s). Cases of RS, defined as syncope with bradycardia and hypotension preceded by vagal trigger(s), between 1/2021 and 12/2021 were used as controls. For the secondary analysis, RMCA outcomes were compared to in-hospital cardiac arrest (IHCA) of other causes. ResultsWe identified 46 RMCA and 67 RS cases. Compared to RS patients, RMCA patients were more likely to have spinal cord injury (13.0% vs 1.5%, p = 0.02). Airway clearance i.e., coughing and suctioning triggered a higher proportion of RMCA events than RS events (23.9% vs 3.0%, p < 0.01). Compared to 1,021 IHCAs of other causes, RMCAs had 100% return of spontaneous circulation, were more likely to survive to discharge (84.8% vs 36.2%, p < 0.001) and have favorable neurological outcomes (cerebral performance category 1 or 2, 58.7% vs 26.9%, p < 0.001). ConclusionsRMCA has a favorable prognosis compared to other IHCAs and is potentially preventable. Spinal cord injury and airway clearance were patient factors significantly associated with RMCA.

Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program improves chest compression rate in real world out-of hospital cardiac arrest patients

BackgroundThe Resuscitation Quality Improvement® (RQI®) HeartCode Complete® program is designed to enhance cardiopulmonary resuscitation (CPR) training by using real-time feedback manikins. Our objective was to assess the quality of CPR, such as chest compression rate, depth, and fraction, performed on out-of-hospital cardiac arrest (OHCA) patients among paramedics trained with the RQI® program vs. paramedics who were not. Methods and ResultsAdult OHCA cases from 2021 were analyzed; 353 OHCA cases were classified into one of three groups: 1) 0 RQI®-trained paramedics, 2) 1 RQI®-trained paramedic, and 3) 2–3 RQI®-trained paramedics. We reported the median of the average compression rate, depth, and fraction, as well as percent of compressions that were between 100 to 120/minute and percent of compressions that were 2.0 to 2.4 inches deep. Kruskal-Wallis Tests were used to assess differences in these metrics across the three groups of paramedics. Of 353 cases, the median of the average compression rate/minute among crews with 0, 1, and 2–3 RQI®-trained paramedics was 130, 125, and 125, respectively (p = 0.0032). Median percent of compressions between 100 to 120 compressions/minute was 10.3%, 19.7%, and 20.1% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.0010). Median of the average compression depth was 1.7 inches across all three groups (p = 0.4881). Median compression fraction was 86.4%, 84.6%, and 85.5% among crews with 0, 1, and 2–3 RQI®-trained paramedics, respectively (p = 0.6371). ConclusionsRQI® training was associated with statistically significant improvement in chest compression rate, but not improved chest compression depth or fraction in OHCA.

Innovative Cardiopulmonary Resuscitation Instruction: One School of Nursing's Experience Piloting the NLN, Laerdal, and American Heart Association Resuscitation Quality Improvement Program.

Innovative Cardiopulmonary Resuscitation Instruction: One School of Nursing's Experience Piloting the NLN, Laerdal, and American Heart Association Resuscitation Quality Improvement Program.

Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021

The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021. To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology &amp; Public Health; Prehospital Resuscitation; In-Hospital Resuscitation &amp; Post-Arrest Care; Prognostication &amp; Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication. Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively. Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation.

Resuscitation Quality Improvement (RQI®).

Cardiopulmonary resuscitation (CPR) is a fundamental skill for all health care providers. Annual skills reviews and certification checks are the time-honored tradition for tracking and evaluating such skills. The assumption that CPR retraining in its traditional form is a sufficient measure of basic competence has been challenged by recent studies, and technical evaluations of the efficacy of CPR competence of certified nurses have surfaced significant gaps. Nursing schools and employers can bridge those gaps with Resuscitation Quality Improvement (RQI®). [J Contin Educ Nurs. 2022;53(9):393-394.].

Neonatal Resuscitation Program Resuscitation Quality Improvement Implementation Across a Multihospital Delivery System

The Neonatal Resuscitation Program Resuscitation Quality Improvement (NRP RQI) is a new program as of Fall 2021; we focus on how to implement this new program.

Intensive Care Unit Nurses' Perceptions and Experience Using the American Heart Association Resuscitation Quality Improvement Program

Purpose/Aims The aims of this clinical nurse specialist–led project were to describe the experiences and perceptions of adult intensive care unit nurses using the resuscitation quality improvement (RQI) program as the primary method for resuscitation education and retraining in a community hospital and to form recommendations for improving the RQI experience for participants based on the responses of participants as part of a quality improvement project. Description of the Project An online survey from a convenience sampling of registered nurses in an intensive care unit (N = 28) was done to obtain feedback regarding their perceptions of the RQI program. Analyses of the responses were performed separately by 3 investigators using principles of content analysis before obtaining consensus on themes to increase validity by triangulation. Outcome Themes emerged regarding the beneficial nature of the RQI program as a cardiopulmonary resuscitation learning strategy, such as increased frequency for the practice of compression and ventilation skills that included real-time feedback and increased knowledge of the roles of resuscitation team members. However, themes reflecting cumbersome aspects of using the RQI program were also revealed, such as technological and mechanical shortcomings, the structure of the manikins and ergonomics of the RQI environment, time away from patient care to complete RQI requirements, and lack of resuscitation team interactions. Conclusion Removing or mitigating barriers that hamper efficient use of nursing time using a quality improvement framework may enhance the RQI experience and program delivery, resulting in improved in-hospital cardiac arrest patient care.

Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes. To evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings. A parallel, hybrid stepped-wedge, cluster randomized trial (Improving Outcomes from Pediatric Cardiac Arrest-the ICU-Resuscitation Project [ICU-RESUS]) involving 18 pediatric intensive care units (ICUs) from 10 clinical sites in the US. In this hybrid trial, 2 clinical sites were randomized to remain in the intervention group and 2 in the control group for the duration of the study, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The index (first) CPR events of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were followed up to hospital discharge (final follow-up was April 30, 2021). During the intervention period (n = 526 patients), a 2-part ICU resuscitation quality improvement bundle was implemented, consisting of CPR training at the point of care on a manikin (48 trainings/unit per month) and structured physiologically focused debriefings of cardiac arrest events (1 debriefing/unit per month). The control period (n = 548 patients) consisted of usual pediatric ICU management of cardiac arrest. The primary outcome was survival to hospital discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline (score range, 1 [normal] to 6 [brain death or death]). The secondary outcome was survival to hospital discharge. Among 1389 cardiac arrests experienced by 1276 patients, 1129 index CPR events (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included and 1074 were analyzed in the primary analysis. There was no significant difference in the primary outcome of survival to hospital discharge with favorable neurologic outcomes in the intervention group (53.8%) vs control (52.4%); risk difference (RD), 3.2% (95% CI, -4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). There was also no significant difference in survival to hospital discharge in the intervention group (58.0%) vs control group (56.8%); RD, 1.6% (95% CI, -6.2% to 9.7%); adjusted OR, 1.03 (95% CI, 0.73 to 1.47). In this randomized clinical trial conducted in 18 pediatric intensive care units, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing, compared with usual care, did not significantly improve patient survival to hospital discharge with favorable neurologic outcome among pediatric patients who experienced cardiac arrest in the ICU. ClinicalTrials.gov Identifier: NCT02837497.

Comparison of Recertification Methods on CPR Quality.

High-quality cardiopulmonary resuscitation (CPR) is vital to improving survival from cardiac arrest. This study compared participant performance of CPR with three American Heart Association (AHA)-approved CPR recertification programs because current literature does not show which method is superior. Our goal is to investigate the best training methods to deliver high-quality CPR. Participants were within 90 days of recertification in face-to-face, Heart Code, or Resuscitation Quality Improvement (RQI). No statistically significant differences were found among training modalities or demographic characteristics. The only significant difference was among those who had performed CPR on a human. Mean scores for the three modalities did not reach the passing requirement for AHA, suggesting that one method of CPR training is not better than the others. Recommendations for translating these findings into clinical practice include mock codes with the ability to measure CPR metrics and simulations of cardiac responses to provide vicarious CPR experience. [J Contin Educ Nurs. 2022;53(1):43-48.].

Abstract 12583: Low-Dose, High-Frequency Psychomotor CPR Skills Training Results in Improved and Sustained Performance of Optimal Adult/Child Ventilations in Fire-Based EMS Personnel

Background: Hyper/over-ventilation (HOV) negatively effects cerebral blood and coronary artery flow during cardiac arrest. The resuscitation quality improvement (RQI) model of low-dose, high-frequency (LDHF) CPR training has been shown to improve CPR skills. Due to the deleterious impact of HOV on survival, our study seeks to determine if the RQI model improves ventilation skills for EMS personnel. We test the hypothesis that the RQI training results in improved and sustained ventilation performance. Methods: In 2014, our department transitioned from traditional BLS/ACLS training to the RQI model. Performance metrics are captured automatically for each rescuer on a quarterly basis using high-fidelity mannequins. Inclusion: All data from adult RQI attempts by EMS personnel from 2015-2019. Exclusion: attempts by non-EMS personnel. The 1 outcome measure is the overall mean (95% CI) ventilation score (composite measure, range 0-100, derived from average volume/rate and % with correct volume). The 2nd outcome measure is the proportion (95%CI) of rescuers with ventilation scores &gt;90%. Data were extracted from RQI and analyzed with Prism statistical software. Comparisons for the 1 outcome was performed using one-way ANOVA and we report mean and 95% CI and proportions and 95% CI as appropriate. Results: During the study period, 740 personnel completed 1,490 ventilation activities in the baseline period and 5,077 in the subsequent years. The mean (95% CI) composite ventilation scores for the baseline was 84.10 (83.09,85.10) vs 2016 = 83.13 (82.17,84.09), 2017=88.79 (87.91,89.66), 2018=90.36 (89.45, 91.27), 2019= 88.59 (87.37, 89.81) for years 2016-2019; F= 41.36, R2=0.024, p value &lt;0.0001. 10outcome: In the baseline RQI year, there were 55.3 % (95%CI= 52.8,57.8) participants with composite ventilation scores &gt;/=90% vs. 2016= 53.5% (51.2,55.8), 2017=65.2%(62.6,68.6), 2018= 71.7%(69.1,74.3) and 2019=69.3%(66.1,72.2) in subsequent years. Limitations: Individual performance not reported, single agency. Conclusions: LDHF CPR training improves proper, and exceptional, ventilation performance in fire-based EMS personnel. Our results may be useful for other EMS agencies who are considering transitioning to LDHF training such as the RQI system.

Abstract 14159: Characteristics and Outcomes in COVID-19 Pediatric In-Hospital Cardiac Arrest Patients

Introduction: Survival of adult patients with COVID-19 who had an in-hospital cardiac arrest (IHCA) are poor. Characteristics and outcomes for pediatric IHCA patients with COVID-19 are unknown. Hypothesis: We hypothesized that pediatric COVID-19 patients would have worse survival outcomes when compared to non-COVID patients. Methods: A multicenter, multinational cohort of pediatric IHCA in the pediRES-Q collaborative were reviewed (March 1, 2020 - April 1, 2021). We characterized patients with COVID-19 compared to patients without COVID-19 and investigated whether COVID-19 was associated with survival outcomes using multivariate logistic regression with mixed effects. Results: We identified 362 pediatric IHCAs of which 14 were COVID-19 positive. For non-COVID-19 vs COVID-19 patients respectively, median [Q1; Q3] age was 1.0 [0.3; 7.1] vs. 7.1 [1.5; 14.0] years and 42% vs. 43% were female. Immediate cause of arrest was hypotension: 8% vs. 43%, respiratory decompensation: 19% vs. 21%, and hypoxia 22% vs. 36% for non-COVID-19 vs. COVID-19 patients. For non-COVID-19 vs COVID-19 patients, total CPR duration was 10 [4; 33] min vs 19 [5; 33] min (for non-return of spontaneous circulation (ROSC) cases only: 35 [20; 55] min vs 34 [24; 34] min). For non-COVID-19 vs COVID-19 patients, ROSC was 79% vs. 57%, aOR: 0.48 (95% CI: 0.24-0.98), survival to hospital discharge was 45% vs. 29%, aOR: 0.63 (95% CI: 0.25-1.57) and survival with favorable neurological outcome was 39% vs. 21%, aOR: 0.51 (95% CI: 0.16-1.65). Conclusions: In a pediatric resuscitation quality improvement collaborative, pediatric IHCA patients with COVID-19 were older when compared to non-COVID-19 patients. Median CPR duration was &gt;30 minutes for COVID-19 non-survivors, COVID-19 patients had lower chance of ROSC when compared to non-COVID-19 patients but considerably better survival outcomes than those reported for adults.

Abstract 14218: Post-Cardiac Arrest Care Delivery Varies Widely Across Institutions Belonging to the PediRES-Q Collaborative

Introduction: Despite national pediatric post-cardiac arrest care (PCAC) guidelines to improve survival and neurological outcomes, there are limited studies describing PCAC delivery in pediatric institutions. The objective of this study was to describe reported PCAC delivery in pediatric institutions. We hypothesized that there would be variability in PCAC processes across institutions. Methods: An IRB-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution belonging to the international Pediatric Resuscitation Quality Improvement collaborative (PediRES-Q). Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data. Results: Twenty-four of 47 centers completed the survey (51%). Most respondents (58%) belonged to large centers (≥1000 annual PICU admissions). Two-third (67%) of centers reported using no specific selection criteria to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Smaller centers (&lt;1000 annual PICU admissions) more frequently reported the use of attending-directed care for PCAC initiation/delivery (80%) versus larger centers (57%), p = 0.04. Common PCAC targets included temperature (96%), glucose (75%), and age-based blood pressure (88%). Most PCAC included EEG (75%) but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological exam (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities (Figure 1). Conclusions: There is wide variation in PCAC delivery among surveyed pediatric institutions. Targeting common themes such as standardization of PCAC initiation and bundle components and implementing adherence evaluation could improve PCAC.

The NRP 8th Edition: Innovation in Education.

The American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program® (NRP®) 8th-Edition materials were released in June 2021 and must be in use by January 1, 2022. Ongoing international review and consensus of resuscitation science since 2015 has yielded no major changes in practice. However, the NRP Steering Committee revised several practices in the interest of patient safety and educational efficiency. The NRP 8th Edition offers NRP Essentials and NRP Advanced levels of learning and 2 recommended Provider Course formats. In most hospitals, NRP Essentials and NRP Advanced will be taught using instructor-led Provider Courses. Resuscitation Quality Improvement® (RQI® for NRP®), a self-directed learning program that uses low-dose, high-frequency quarterly learning and skills sessions, may be used in hospitals that already use RQI for life support education.