Preventing Cardiac Arrest in the Pediatric Cardiac Intensive Care Unit Through Multicenter Collaboration.

Autor:	Alten J; Department of Pediatrics, University of Cincinnati School of Medicine, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio., Cooper DS; Department of Pediatrics, University of Cincinnati School of Medicine, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio., Klugman D; Division of Cardiac Critical Care Medicine, Children's National Hospital, Washington, DC.; Division of Anesthesia, Critical Care Medicine, Johns Hopkins Children's Center, Baltimore, Maryland., Raymond TT; Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas., Wooton S; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Garza J; Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas., Clarke-Myers K; Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio., Anderson J; Department of Pediatrics, University of Cincinnati School of Medicine, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio., Pasquali SK; Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor., Absi M; Department of Pediatrics, Heart Institute, University of Tennessee, Le Bonheur Children's Hospital, Memphis., Affolter JT; Department of Pediatrics, Critical Care Medicine, University of Missouri, Children's Mercy Hospital, Kansas City.; Department of Pediatrics, University of Texas at Austin-Dell Medical School, Dell Children's Medical Center of Central Texas, Austin., Bailly DK; Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City., Bertrandt RA; Department of Pediatric Critical Care, Medical College of Wisconsin, Children's Wisconsin, Milwaukee., Borasino S; Department of Pediatrics, University of Alabama at Birmingham, Cardiac Critical Care, Birmingham., Dewan M; Department of Pediatrics, University of Cincinnati School of Medicine, Division of Critical Care Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio., Domnina Y; Division of Cardiac Critical Care Medicine, Children's National Hospital, Washington, DC.; Department of Pediatrics and Critical Care Medicine, Cardiac Intensive Care Unit, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Lane J; Division of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix Arizona., McCammond AN; Department of Pediatrics, Pediatric Cardiac Intensive Care, University of California San Francisco, Benioff Children's Hospital, San Francisco., Mueller DM; Department of Pediatrics, Division of Critical Care, University of Washington, Seattle Children's Hospital, Seattle.; Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego., Olive MK; Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor., Ortmann L; Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha., Prodhan P; Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock., Sasaki J; Division of Cardiac Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida.; Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, New York., Scahill C; Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora., Schroeder LW; Department of Pediatrics, Medical University of South Carolina, Charleston., Werho DK; Division of Cardiology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego., Zaccagni H; Department of Pediatrics, University of Alabama at Birmingham, Cardiac Critical Care, Birmingham., Zhang W; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor., Banerjee M; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.; Department of Biostatistics, University of Michigan, Ann Arbor., Gaies M; Department of Pediatrics, University of Cincinnati School of Medicine, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
Jazyk:	angličtina
Zdroj:	JAMA pediatrics [JAMA Pediatr] 2022 Oct 01; Vol. 176 (10), pp. 1027-1036.
DOI:	10.1001/jamapediatrics.2022.2238
Abstrakt:	Importance: Preventing in-hospital cardiac arrest (IHCA) likely represents an effective strategy to improve outcomes for critically ill patients, but feasibility of IHCA prevention remains unclear. Objective: To determine whether a low-technology cardiac arrest prevention (CAP) practice bundle decreases IHCA rate. Design, Setting, and Participants: Pediatric cardiac intensive care unit (CICU) teams from the Pediatric Cardiac Critical Care Consortium (PC4) formed a collaborative learning network to implement the CAP bundle consistent with the Institute for Healthcare Improvement framework; 15 hospitals implemented the bundle voluntarily. Risk-adjusted IHCA incidence rates were analyzed across 2 time periods, 12 months (baseline) and 18 months after CAP implementation (intervention) using difference-in-differences (DID) regression to compare 15 CAP and 16 control PC4 hospitals that chose not to participate in CAP but had IHCA rates tracked in the PC4 registry. Patients deemed at high risk for IHCA, based on a priori evidence-based criteria and empirical hospital-specific criteria, were selected to receive the CAP bundle. Data were collected from July 2018 to December 2019, and data were analyzed from March to August 2020. Interventions: CAP bundle included 5 elements developed to promote increased situational awareness and communication among bedside clinicians to recognize and mitigate deterioration in high-risk patients. Main Outcomes and Measures: Risk-adjusted IHCA incidence rate across all CICU admissions (IHCA events divided by all admissions). Results: The bundle was activated in 2664 of 10 510 CAP hospital admissions (25.3%); admission characteristics were similar across study periods. There was a 30% relative reduction in risk-adjusted IHCA incidence rate at CAP hospitals (intervention period: 2.6%; 95% CI, 2.2-2.9; baseline: 3.7%; 95% CI, 3.1-4.0), but no change at control hospitals (intervention period: 2.7%; 95% CI, 2.3-2.9; baseline: 2.7%; 95% CI, 2.2-3.0). DID analysis confirmed significantly reduced odds of IHCA among all admissions at CAP hospitals compared with control hospitals during the intervention period vs baseline (odds ratio, 0.72; 95% CI, 0.56-0.91; P = .01). DID odds ratios were 0.72 (95% CI, 0.53-0.98) for the surgical subgroup, 0.74 (95% CI, 0.48-1.14) for the medical subgroup, and 0.72 (95% CI, 0.50-1.03) for the high-risk admission subgroup at CAP hospitals after intervention. All-cause risk-adjusted mortality rate did not change after intervention. Conclusions and Relevance: Implementation of this CAP bundle led to significant IHCA reduction across multiple pediatric CICUs. Future studies may determine if this bundle can be effective in other critically ill populations.
Databáze:	MEDLINE
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