To implement a comprehensive cardiac arrest prevention bundle in a UK pediatric intensive care unit (PICU) to reduce the incidence of cardiac arrest in children with cardiac conditions.
Approach:
Implementation of CA Prevention Bundle: A cardiac arrest prevention bundle was implemented for patients with a primary cardiac diagnosis admitted to the PICU, with monitoring of risk-adjusted cardiac arrest rates.
Monitoring and Evaluation: Risk-adjusted cardiac arrest rates were monitored using sequential probability ratio test monitoring, comparing a retrospective baseline period of 1 year with the post-intervention period.
Key Findings:
In 1113 patients with a primary cardiac diagnosis admitted to the PICU, the crude cardiac arrest rate reduced from 6.2% in the pre-intervention period to 4.4% in the 18 months post intervention (relative reduction of 30%).
The cardiac surgical cohort showed a significant reduction in cardiac arrest incidence, indicating a high probability of special cause variation.
The UK national mortality prediction algorithm (Partial Risk Adjustment in Surgery) showed reasonable correlation with the risk prediction algorithm for cardiac arrest derived from North American data.
Interpretation:
The implementation of a comprehensive quality improvement program can lead to a reduction in cardiac arrests in pediatric patients with heart disease, particularly in those post-cardiac surgery.
Limitations:
The intervention was only effective in patients admitted after cardiac surgery, with no improvement noted in cardiac medical admissions.
Further investigation is needed to understand the lack of improvement in cardiac medical admissions.
Conclusion:
Some cardiac arrests in children with heart disease can be prevented through a structured quality improvement program, though standardization of risk adjustment methodology is necessary.
