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Observational Study
. 2024 Sep 3;7(9):e2432393.
doi: 10.1001/jamanetworkopen.2024.32393.

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units

Dana Mueller  1 , David K Bailly  2 , Mousumi Banerjee  3 , R A Bertrandt  4 , Santiago Borasino  5 , Mario Briceno-Medina  6 , Titus Chan  7 , J Wesley Diddle  8 , Yuliya Domnina  9 , Katherine Clarke-Myers  10 , Chloe Connelly  10 , Amy Florez  10 , Michael Gaies  10 , Janie Garza  11 , Rod Ghassemzadeh  12 , John Lane  13 , Amy N McCammond  14 , Mary K Olive  15 , Laura Ortmann  16 , Parthak Prodhan  17 , Tia Tortoriello Raymond  11 , Jun Sasaki  18 , Carly Scahill  19 , Luke W Schroeder  20 , Kurt R Schumacher  15 , David K Werho  1 , Wenying Zhang  3 , Jeffrey Alten  10 ; PC4 CAP Collaborators
Collaborators, Affiliations
Observational Study

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units

Dana Mueller et al. JAMA Netw Open. .

Abstract

Importance: The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined.

Objective: To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement.

Design, setting, and participants: This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP-participating hospitals.

Intervention: The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work.

Main outcomes and measures: Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed.

Results: There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, -0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up.

Conclusions and relevance: In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Diddle reported receiving personal fees from Mallinckrodt Pharmaceuticals outside the submitted work. Dr Raymond reported receiving personal fees from the New England Research Institute outside the submitted work. Dr Werho reported receiving grants from the American Heart Association and personal fees from Nutricia Inc outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. In-Hospital Cardiac Arrest (IHCA) Incidence Rate During the Cardiac Arrest Prevention (CAP) and Follow-Up Eras vs Quality Improvement (QI) Sustainability Score
Higher QI sustainability scores in the follow-up era were associated with a statistically lower IHCA incidence rate and vice versa.
See this image and copyright information in PMC

References

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