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Reducing Cardiac Arrests in the Pediatric Cardiac ICU

A recent study that included research at Medical City Children’s Hospital is helping improve and save the lives of children in cardiac intensive care units (CICU). The study included 15 hospitals nationally with a goal to reduce the incidence of cardiac arrest in this vulnerable patient population.

In the study published July 5 in JAMA Pediatrics, the group of investigators report that implementing several low-technology cardiac arrest prevention tactics reduced in-hospital cardiac arrest in the pediatric CICU an average of 30% across the participating centers. Many experts have considered in-hospital cardiac arrest a largely unavoidable outcome for some children in CICUs.

“We are honored to have been selected as the only children’s hospital in North Texas to participate as an intervention hospital in this landmark study,” says Jay deVenny, CEO of Medical City Children’s Hospital. “The reduction of cardiac arrests as a result of this research demonstrates our highly-skilled and compassionate colleagues’ dedication to ensuring the best possible outcomes for our patients.”

The study was conducted within a collaborative learning network of CICU teams across the Pediatric Cardiac Critical Consortium (PC4), which aims to improve the quality of care to patients with critical pediatric and congenital cardiovascular disease in North America and abroad. Each institution implemented a “bundle” of cardiac arrest prevention (CAP) practices, including a twice-daily huddle with the bedside nurse, nurse leader, attending physician, first-responding provider and respiratory therapist. The goal is for the entire team to recognize early deterioration and have a plan of action specific to each patient, such as pre-drawn medications.

"Implementation of such an innovative project requires a multidisciplinary approach.” says Janie Garza, RN, assistant vice president of pediatric cardiac and neonatal services. “The CICU team demonstrated the highest level of commitment, diligence and collaboration to achieve these results."

Pediatric cardiac intensivist Tia Raymond, MD, was the physician lead investigator at Medical City Children’s Hospital, which has enrolled more than 200 patients in the study since 2018.

“The best CPR is no CPR,” says Dr. Raymond. “This project was able to prevent CPR in almost 200 high-risk pediatric patients at these 15 hospitals helping to create healthier tomorrows for these children.”

Future studies are needed to determine which CAP bundle elements are most necessary for cardiac arrest prevention. Investigators say that while the details of interventions would vary, the core elements of the CAP bundle program could be adapted to other critically ill populations, such as general pediatric and adult intensive care patients, and adult cardiovascular ICUs.

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