Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action

TL;DR

This study highlights inconsistent postcardiac arrest care practices in pediatric intensive care units, despite existing national guidelines.

Contribution

The study provides a detailed survey-based analysis of PCAC delivery in pediatric institutions and identifies key implementation barriers.

Findings

Only 67% of centers had a specific process to initiate PCAC, with others using informal methods.

Common PCAC targets included temperature, age-based blood pressure, and glucose.

Only 25% of centers had a mechanism to evaluate PCAC adherence.

Abstract

Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative.

An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data.

Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities.

There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.