Preventing Cardiac Arrest in Pediatric ICUs: Sustained Success in Study from Rady Children’s
A groundbreaking, collaborative study from the Pediatric Cardiac Critical Care Consortium (PC4) and first authored by Dana Mueller, MD, a pediatric cardiac intensivist at Rady Children’s Hospital-San Diego, shows that hospitals can not only reduce in-hospital cardiac arrest (IHCA) rates in pediatric cardiac intensive care units, but also sustain those improvements over time—if they remain committed to key prevention practices.
The study, “Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units,” published in JAMA Network Open, explores how hospitals that participated in the Cardiac Arrest Prevention (CAP) quality improvement project maintained lower IHCA rates and identified factors crucial for long-term success. Dr. Mueller’s expertise was pivotal in analyzing the results and offering valuable insights into the sustainability of quality improvement efforts in critical care settings.
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 the impact of 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 generally reflected 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. Risk-adjusted IHCA incidences were not different between the CAP and follow-up eras, suggesting sustained prevention improvement. Lower hospital QI sustainability scores were correlated with higher odds of IHCA in the follow-up era. Hospitals with increased IHCA rates had significantly lower QI sustainability scores and were less likely to report persistent engagement for CAP-related QI processes.
Conclusions and Relevance: In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention remained feasible and sustainable; the established reduction in risk-adjusted IHCA rates 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 strongly associated with sustained improvement.