Improved Cardiopulmonary Resuscitation Performance With CODE ACES ² : A Resuscitation Quality Bundle

Abstract

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 ACES 2 ). 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 ACES 2 was associated with progressively increased compliance with AHA CPR guidelines during in‐hospital cardiac arrest.

Cardiac arrest in the paediatric intensive care unit: defining the problem and developing solutions

“… 6 The use of resuscitation quality bundles like the CPR Coaching, Objective-Data Evaluation, Action-linked-phrases, Choreography, Ergonomics, Structured debriefing and Simulation (CODE ACES 2) have been associated with increased AHA CPR guideline compliance during in-hospital arrests. 7 The use of multidisciplinary performance debriefing tools not only improves team performance, but improves patients short-term outcomes. 8 …”

Cold Debriefings after In-hospital Cardiac Arrest in an International Pediatric Resuscitation Quality Improvement Collaborative

“…Debriefing after resuscitation attempts is associated with improved quality of chest compressions in simulated and clinical cardiac arrests. 1 , 3 , 14 , 15 Rates of return of spontaneous circulation 3 and survival to hospital discharge with good neurologic function improved after implementation of a CD program. 1 Additionally, a comprehensive clinical event review in a pediatric cardiac center described issues with communication in 62% of events followed by environment/policy, then patient care concerns.…”

More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland)

“…This also supports the resuscitation leader so she/he can focus on other aspects during resuscitation. In the presence of CPR feedback technology, the addition of a trained CPR coach into resuscitation teams adds to CPR quality metrics which in turn are associated with improved survival outcomes from pediatric cardiac arrest (32)(33)(34).…”