What are we missing? Arrhythmia detection in the pediatric intensive care unit

Abstract

Objectives: To test the hypothesis that instituting a process of routine daily review of rhythm alarms in non-cardiac patients in the pediatric intensive care unit would yield clinically important disturbances that would otherwise go undetected.

Study design: A prospective observational study was performed over a consecutive 28-day period. Total bedside monitor alarms, rhythm alarms, and heart rate (HR) trends were recorded. Rhythm alarm recordings were reviewed independently by two study team members. Medical records for patients with critical arrhythmias were reviewed to evaluate for prior knowledge of the event and to correlate with clinical data.

Results: We evaluated 86 patients (343 patient-days). There were 54,656 total monitor alarms (159.3 alarms/patient-day), of which 19,970 (37%) were rhythm alarms, including 4032 (20%) critical arrhythmias. Fifty-six percent of the critical alarms were artifactual. Seventeen of the 1786 ventricular tachycardia alarms represented true episodes that occurred in 5 patients. Two patients' care were altered as a result of detection of the arrhythmia in the review process. Eight hundred sixty-five (98%) of the 883 true critical alarms reviewed were for extreme HR. Eighty-three percent (5172) of the 6239 true non-critical alarms reviewed were HR alarms.

Conclusions: Daily review of rhythm alarms improves detection of clinically relevant arrhythmias in non-cardiac pediatric intensive care unit patients.

Keywords: CCMC; Cohen Children's Medical Center; ECG; Electrocardiograph; HR; Heart rate; ICU; Intensive care unit; PICU; PVC; Pediatric intensive care unit; Premature ventricular contraction; VT; Ventricular tachycardia.