Objectives

To evaluate if a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings improves outcomes in children that experience in-hospital cardiac arrest.

Background

Pediatric cardiac arrest affects thousands of hospitalized children each year. Approximately 60% of children who experience cardiac arrest do not survive to hospital discharge. Higher quality cardiopulmonary resuscitation (CPR) is more effective at saving lives, however, providing high quality care during the resuscitation of a child is difficult.

In a single-center study, a novel bundled intervention of CPR training at the point of care and post–cardiac arrest event debriefing improved survival to hospital discharge with favorable neurologic outcome in pediatric patients who underwent CPR in an intensive care unit (ICU). The ICU-RESUS study was initiated to evaluate if this bundled intervention was generalizable to other pediatric institutions.

Participants

Individuals ≥ 37 weeks and ≤ 18 years of age who received CPR in an ICU were eligible to participate. Exclusion criteria included brain death prior to CPR, or an out-of-hospital cardiac arrest associated with the current hospitalization.

A total of 1074 participants were enrolled. 526 participants received the intervention, and 548 participants received standard resuscitation practices following cardiac arrest.

Design

ICU-RESUS was a parallel, hybrid stepped-wedge, cluster randomized multicenter trial. The trail was conducted in 18 ICUs across 10 clinical sites. 2 clinical sites were randomized to remain in the intervention group and 2 clinical sites were randomized to remain in the control group for the duration of the study, while the remaining 6 clinical sites were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The intervention was a 2-part ICU resuscitation quality improvement bundle consisting of CPR training at the point of care on a manikin and structured reviews of each cardiac arrest that emphasize patient-centric physiology intended to optimize intra-arrest and post-arrest care. Participants in the control group were treated according to the existing resuscitation practices at the ICUs.

Participant characteristics, such as diagnoses prior to cardiac arrest and illness category (medical or surgical) were collected. Characteristics of the CPR event were also collected, including cause of the CPR event, first documented rhythm, duration of CPR, and pharmacological interventions.

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]).

Conclusions

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.

ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health; Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups, Sutton RM, et al. Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs: A Randomized Clinical Trial. JAMA. 2022;327(10):934-945. doi:10.1001/jama.2022.1738

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