Introduction:
Hospitalized children with critical cardiac disease experience cardiac arrest more than any other disease type. Varying models are devoted to caring for this population, including pediatric intensive care units (PICU) and dedicated cardiac intensive care units (CICU). The process of CPR delivery has not been evaluated in CICUs in comparison to PICUs.
Hypothesis:
There will be no difference in cardiac arrest resuscitation practices between unit types.
Methods:
We analyzed patients <18 years from the American Heart Association Get with the Guidelines-Resuscitation database (GWTG-R) with an illness category of medical or surgical cardiac disease who received CPR in a CICU or PICU from 2014 to 2018. Events were assessed for compliance with GWTG-R achievement measures of time to first chest compressions ≤ 1 minute, time to IV/IO epinephrine ≤ 5 minutes, time to first shock ≤ 2 minutes for VF/pulseless VT first documented rhythm, and confirmation of endotracheal tube (ETT) placement in trachea.
Results:
CPR practices were evaluated on 866 patients, 687 CICU and 179 PICU (55% male and 65% neonatal). Surgical cardiac disease was present in 56%. Cardiac malformations were present in 81% (45% cyanotic 29% acyanotic). Pulseless arrest was the initial event in 41% with a shockable rhythm in 14%. Return of spontaneous circulation occurred in 86% and survival to hospital discharge in 58%. Univariate analysis comparing resuscitation practice is shown in Table 1. ECPR use was the only variable noted to be significantly different between units (CICU 22% vs PICU 6%, P<0.01). On multivariate analysis, there were no differences in GWTG-R achievement measures between ICU types for ETT placement confirmation, time to IV/IO epinephrine dose, time to first chest compression to first shock (P>0.05).
Conclusion:
Despite differences in infrastructure, process, and provider expertise, there were no differences in cardiac arrest resuscitation practice between CICUs and PICUs.
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