Improved cardiopulmonary resuscitation performance with CODE ACES2: A resuscitation quality bundle

Elizabeth Hunt, Justin Jeffers, Le Ann McNamara, Heather Newton, Kenneth Ford, Meghan Bernier, Elizabeth Tucker, Kareen Jones, Caitlin O’Brien, Pamela Dodge, Sarah Vanderwagen, Cheryl Salamone, Tamara Pegram, Michael Rosen, Heather M. Griffis, Jordan Duval-Arnould

Research output: Contribution to journalArticle

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 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.

Original languageEnglish (US)
Article numbere009860
JournalJournal of the American Heart Association
Volume7
Issue number24
DOIs
StatePublished - Dec 1 2018

Fingerprint

Cardiopulmonary Resuscitation
Resuscitation
Thorax
Heart Arrest
Human Engineering
Guidelines
Data Compression
American Heart Association
Pediatric Hospitals
Defibrillators
Compliance
Observational Studies
Logistic Models
Odds Ratio
Prospective Studies
Confidence Intervals
Pediatrics
Weights and Measures

Keywords

  • Cardiopulmonary arrest
  • Cardiopulmonary resuscitation (CPR)
  • Emergency cardiac care
  • Pediatrics
  • Quality and outcomes
  • Quality improvement
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Improved cardiopulmonary resuscitation performance with CODE ACES2 : A resuscitation quality bundle. / Hunt, Elizabeth; Jeffers, Justin; McNamara, Le Ann; Newton, Heather; Ford, Kenneth; Bernier, Meghan; Tucker, Elizabeth; Jones, Kareen; O’Brien, Caitlin; Dodge, Pamela; Vanderwagen, Sarah; Salamone, Cheryl; Pegram, Tamara; Rosen, Michael; Griffis, Heather M.; Duval-Arnould, Jordan.

In: Journal of the American Heart Association, Vol. 7, No. 24, e009860, 01.12.2018.

Research output: Contribution to journalArticle

Hunt, Elizabeth ; Jeffers, Justin ; McNamara, Le Ann ; Newton, Heather ; Ford, Kenneth ; Bernier, Meghan ; Tucker, Elizabeth ; Jones, Kareen ; O’Brien, Caitlin ; Dodge, Pamela ; Vanderwagen, Sarah ; Salamone, Cheryl ; Pegram, Tamara ; Rosen, Michael ; Griffis, Heather M. ; Duval-Arnould, Jordan. / Improved cardiopulmonary resuscitation performance with CODE ACES2 : A resuscitation quality bundle. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 24.
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keywords = "Cardiopulmonary arrest, Cardiopulmonary resuscitation (CPR), Emergency cardiac care, Pediatrics, Quality and outcomes, Quality improvement, Sudden cardiac death",
author = "Elizabeth Hunt and Justin Jeffers and McNamara, {Le Ann} and Heather Newton and Kenneth Ford and Meghan Bernier and Elizabeth Tucker and Kareen Jones and Caitlin O’Brien and Pamela Dodge and Sarah Vanderwagen and Cheryl Salamone and Tamara Pegram and Michael Rosen and Griffis, {Heather M.} and Jordan Duval-Arnould",
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AU - Hunt, Elizabeth

AU - Jeffers, Justin

AU - McNamara, Le Ann

AU - Newton, Heather

AU - Ford, Kenneth

AU - Bernier, Meghan

AU - Tucker, Elizabeth

AU - Jones, Kareen

AU - O’Brien, Caitlin

AU - Dodge, Pamela

AU - Vanderwagen, Sarah

AU - Salamone, Cheryl

AU - Pegram, Tamara

AU - Rosen, Michael

AU - Griffis, Heather M.

AU - Duval-Arnould, Jordan

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N2 - 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.

AB - 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.

KW - Cardiopulmonary arrest

KW - Cardiopulmonary resuscitation (CPR)

KW - Emergency cardiac care

KW - Pediatrics

KW - Quality and outcomes

KW - Quality improvement

KW - Sudden cardiac death

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