• ICU-RESUS and Eunice Kennedy Shriver National Institute of Child Health, Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups, Robert M Sutton, Heather A Wolfe, Ron W Reeder, Tageldin Ahmed, Robert Bishop, Matthew Bochkoris, Candice Burns, J Wesley Diddle, Myke Federman, Richard Fernandez, Deborah Franzon, Aisha H Frazier, Stuart H Friess, Kathryn Graham, David Hehir, Christopher M Horvat, Leanna L Huard, William P Landis, Tensing Maa, Arushi Manga, Ryan W Morgan, Vinay M Nadkarni, Maryam Y Naim, Chella A Palmer, Carleen Schneiter, Matthew P Sharron, Ashley Siems, Neeraj Srivastava, Sarah Tabbutt, Bradley Tilford, Shirley Viteri, Robert A Berg, Michael J Bell, Joseph A Carcillo, Todd C Carpenter, J Michael Dean, Ericka L Fink, Mark Hall, Patrick S McQuillen, Kathleen L Meert, Peter M Mourani, Daniel Notterman, Murray M Pollack, Anil Sapru, David Wessel, Andrew R Yates, and Athena F Zuppa.
• Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia.
• JAMA. 2022 Mar 8; 327 (10): 934945934-945.

ImportanceApproximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes.ObjectiveTo evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings.Design, Setting, And ParticipantsA parallel, hybrid stepped-wedge, cluster randomized trial (Improving Outcomes from Pediatric Cardiac Arrest-the ICU-Resuscitation Project [ICU-RESUS]) involving 18 pediatric intensive care units (ICUs) from 10 clinical sites in the US. In this hybrid trial, 2 clinical sites were randomized to remain in the intervention group and 2 in the control group for the duration of the study, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The index (first) CPR events of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were followed up to hospital discharge (final follow-up was April 30, 2021).InterventionDuring the intervention period (n = 526 patients), a 2-part ICU resuscitation quality improvement bundle was implemented, consisting of CPR training at the point of care on a manikin (48 trainings/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 usual pediatric ICU management of cardiac arrest.Main Outcomes And MeasuresThe primary outcome was survival to hospital discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline (score range, 1 [normal] to 6 [brain death or death]). The secondary outcome was survival to hospital discharge.ResultsAmong 1389 cardiac arrests experienced by 1276 patients, 1129 index CPR events (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included and 1074 were analyzed in the primary analysis. There was no significant difference in the primary outcome of survival to hospital discharge with favorable neurologic outcomes in the intervention group (53.8%) vs control (52.4%); risk difference (RD), 3.2% (95% CI, -4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). There was also no significant difference in survival to hospital discharge in the intervention group (58.0%) vs 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).Conclusions And RelevanceIn this randomized clinical trial conducted in 18 pediatric intensive care units, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing, compared with usual care, did not significantly improve patient survival to hospital discharge with favorable neurologic outcome among pediatric patients who experienced cardiac arrest in the ICU.Trial RegistrationClinicalTrials.gov Identifier: NCT02837497.

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