For a study, researchers sought to assess the efficacy of a bundled intervention that included physiologically focused CPR instruction at the point of care and organized clinical event debriefings. A parallel, stepped-wedge, cluster-randomized study (Improving Outcomes from Pediatric Cardiac Arrest—the ICU-Resuscitation Project [ICU-RESUS]) including 18 pediatric intensive care units (ICUs) from 10 clinical locations in the United States. In the hybrid trial, 2 clinical sites were randomized to remain in the intervention group for the length of the research, two were randomized to remain in the control group, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge approach. The index (initial) CPR episodes of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were tracked until hospital discharge (the final follow-up was April 30, 2021).

A two-part ICU resuscitation quality improvement bundle was implemented during the intervention period (n = 526 patients), consisting of CPR training on a manikin at the point of care (48 pieces of training/unit per month) and structured physiologically focused debriefings of cardiac arrest events (1 debriefing/unit per month). The control period (n=548 patients) consisted of standard pediatric ICU cardiac arrest care. Survival to hospital discharge with a positive neurologic result defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline was the main outcome (score range, 1 [normal] to 6 [brain death or death]). The survival to hospital release was the secondary endpoint. 

About 1,129 index CPR episodes (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included in the primary study of 1,389 cardiac arrests suffered by 1,276 patients. The primary endpoint of survival to hospital discharge with good neurologic outcomes in the intervention group (53.8%) vs. the control group (52.4%) was not significantly different; risk difference (RD), 3.2% (95% CI, 4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). In addition, there was no significant difference in survival to hospital release between the intervention group (58.0%) and the control group (56.8%); RD, 1.6% (95% CI, 6.2% to 9.7%); adjusted OR, 1.03 (95% CI, 0.73 to 1.47).

Compared to usual care, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing did not significantly improve patient survival to hospital discharge with favorable neurologic outcomes among pediatric patients who experienced cardiac arrest in the ICU in the randomized clinical trial conducted in 18 pediatric intensive care units.

Reference:jamanetwork.com/journals/jama/article-abstract/2789660