Improved Cardiopulmonary Resuscitation Performance With CODE ACES2: A Resuscitation Quality Bundle

Background Over 6000 children have an in‐hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives. Methods and Results A prospective observational study of quality of chest compressions (CC) during pediatric in‐hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle. Objectives were to: 1) implement a debriefing program, 2) identify impediments to delivering high quality CC, 3) develop a resuscitation quality bundle, and 4) measure the impact of the resuscitation quality bundle on compliance with American Heart Association (AHA) Pediatric Advanced Life Support CC guidelines over time. Logistic regression was used to assess the relationship between compliance and year of event, adjusting for age and weight. Over 3 years, 317 consecutive cardiac arrests were debriefed, 38% (119/317) had CC data captured via defibrillator‐based accelerometer pads, data capture increasing over time: (2013:13% [12/92] versus 2014:43% [44/102] versus 2015:51% [63/123], P<0.001). There were 2135 1‐minute cardiopulmonary resuscitation (CPR) epoch data available for analysis, (2013:152 versus 2014:922 versus 2015:1061, P<0.001). Performance mitigating themes were identified and evolved into the resuscitation quality bundle entitled CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES2). The adjusted marginal probability of a CC epoch meeting the criteria for excellent CPR (compliant for rate, depth, and chest compression fraction) in 2015, after CPR Coaching, Objective‐Data Evaluation, Action‐linked‐phrases, Choreography, Ergonomics, Structured debriefing and Simulation was developed and implemented, was 44.3% (35.3–53.3) versus 19.9%(6.9–32.9) in 2013; (odds ratio 3.2 [95% confidence interval:1.3–8.1], P=0.01). Conclusions CODE ACES2 was associated with progressively increased compliance with AHA CPR guidelines during in‐hospital cardiac arrest.

[1]  Linda L. Brown,et al.  Optimizing CPR performance with CPR coaching for pediatric cardiac arrest: A randomized simulation-based clinical trial. , 2018, Resuscitation.

[2]  E. Hunt,et al.  Design and Deployment of a Pediatric Cardiac Arrest Surveillance System , 2018, Critical care research and practice.

[3]  R. Berg,et al.  Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative* , 2018, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[4]  Michael J. Bell,et al.  Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival , 2017, Circulation.

[5]  Julianne S. Perretta,et al.  Integration of in-hospital cardiac arrest contextual curriculum into a basic life support course: a randomized, controlled simulation study. , 2017, Resuscitation.

[6]  W. Schweickert,et al.  Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response. , 2016, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[7]  R. Swor,et al.  Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2015, Circulation.

[8]  Julianne S. Perretta,et al.  Using Simulation to Design Choreography for a Cardiopulmonary Arrest Response , 2015 .

[9]  Christie L. Mulvey,et al.  A novel approach to life support training using "action-linked phrases". , 2015, Resuscitation.

[10]  E. Hunt,et al.  276: DEVELOPMENT OF A CARDIOPULMONARY RESUSCITATION NON-TECHNICAL SKILLS SCORING TOOL (CPR-NTS) , 2014 .

[11]  Jenny W Rudolph,et al.  Establishing a Safe Container for Learning in Simulation: The Role of the Presimulation Briefing , 2014, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[12]  J. Studnek,et al.  Introduction of performance coaching during cardiopulmonary resuscitation improves compression depth and time to defibrillation in out-of-hospital cardiac arrest. , 2014, Resuscitation.

[13]  Marie Diener-West,et al.  Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training. , 2014, Resuscitation.

[14]  Akira Nishisaki,et al.  Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes* , 2014, Critical care medicine.

[15]  R. Berg,et al.  Hospital Variation in Survival After Pediatric In-Hospital Cardiac Arrest , 2014, Circulation. Cardiovascular quality and outcomes.

[16]  Benjamin S. Abella,et al.  Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital A Consensus Statement From the American Heart Association , 2013, Circulation.

[17]  Yan Li,et al.  Survival Trends in Pediatric In-Hospital Cardiac Arrests: An Analysis From Get With The Guidelines–Resuscitation , 2012, Circulation. Cardiovascular quality and outcomes.

[18]  D. Graves,et al.  Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: An analysis of the Kids’ Inpatient Database* , 2012, Critical care medicine.

[19]  R. Berg,et al.  Evaluation of quantitative debriefing after pediatric cardiac arrest. , 2012, Resuscitation.

[20]  Renee D Reid,et al.  Impact of resuscitation system errors on survival from in-hospital cardiac arrest. , 2012, Resuscitation.

[21]  Zhi-qiao Chen,et al.  Improving cardiopulmonary resuscitation in the emergency department by real-time video recording and regular feedback learning. , 2010, Resuscitation.

[22]  Mark Terry,et al.  Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[23]  D. S. Derue,et al.  Leadership in Teams: A Functional Approach to Understanding Leadership Structures and Processes , 2010 .

[24]  Eduardo Salas,et al.  The wisdom of collectives in organizations: An update of the teamwork competencies. , 2008 .

[25]  Robert Simon,et al.  Debriefing as formative assessment: closing performance gaps in medical education. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[26]  Lisa M Bellini,et al.  Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing* , 2008, Critical care medicine.

[27]  Benjamin S Abella,et al.  Improving in-hospital cardiac arrest process and outcomes with performance debriefing. , 2008, Archives of internal medicine.

[28]  Elizabeth A. Hunt,et al.  Simulation of In-Hospital Pediatric Medical Emergencies and Cardiopulmonary Arrests: Highlighting the Importance of the First 5 Minutes , 2008, Pediatrics.

[29]  David M. Gaba,et al.  The Role of Debriefing in Simulation-Based Learning , 2007, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[30]  Peter E. Rivard,et al.  Debriefing with good judgment: combining rigorous feedback with genuine inquiry. , 2007, Anesthesiology clinics.

[31]  N. Lurie,et al.  Designing and conducting tabletop exercises to assess public health preparedness for manmade and naturally occurring biological threats , 2007, BMC public health.

[32]  Aleksander P. J. Ellis.  System Breakdown: The Role of Mental Models and Transactive Memory in the Relationship between Acute Stress and Team Performance , 2006 .

[33]  Kevin C. Stagl,et al.  What type of leadership behaviors are functional in teams? A meta-analysis , 2006 .

[34]  M. Hazinski,et al.  Major changes in the 2005 AHA Guidelines for CPR and ECC: reaching the tipping point for change. , 2005, Circulation.

[35]  B. Abella,et al.  Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. , 2005, JAMA.

[36]  Daniel R. Ilgen,et al.  Backing up behaviors in teams: the role of personality and legitimacy of need. , 2003, The Journal of applied psychology.

[37]  A. Edmondson.  Psychological Safety and Learning Behavior in Work Teams , 1999 .

[38]  Mica R. Endsley,et al.  Toward a Theory of Situation Awareness in Dynamic Systems , 1995, Hum. Factors.