Abstract 325: Resuscitation Practices in Pediatric Hospitals: Insights From Get with the Guidelines-Resuscitation

Background: Resuscitation practices for adult in-hospital cardiac arrest (IHCA) vary widely, based on setting and size. Resuscitation practices in pediatric hospitals have not been examined in detail, and whether practices differ between free-standing pediatric hospitals and combined hospitals (which care for adults and children) is unknown. Methods: We conducted a survey of U.S. hospitals that submit data on pediatric IHCA to GWTG-Resuscitation, a large national registry of IHCA, to elicit detailed information on resuscitation practices. Hospitals were categorized as free-standing pediatric hospitals and combined hospitals, and rates of resuscitation practices were compared. Results: A total of 33 hospitals with at least 5 IHCA events between 2015-2019 completed the survey, of which 9 (27.3%) were freestanding pediatric hospitals and 24 (72.7%) were combined hospitals. Overall, 18 (54.5%) hospitals used a device to measure chest compression quality, 2 (6.1%) used a mechanical device to deliver chest compressions, 6 (18.2%) routinely monitored diastolic pressures during resuscitations, 16 (48.5%) had a staff member monitor chest compression quality, 10 (30.3%) used lanyards or hats to designate leaders during a resuscitation, 16 (48.5%) routinely conducted immediate code debriefings, and 7 (21.2%) conducted mock codes at least quarterly and 17 (51.5%) reported no set schedule. Freestanding pediatric hospitals were more likely to employ a device to measure chest compressions (88.9% vs. 41.7%; P=0.016), conduct code debriefing always or frequently after resuscitations (77.8% vs. 37.5%, P=0.044), use lanyards or a hat to designate the code team leader during resuscitations (66.7% vs. 16.7%, P=0.006), and allow nurses to defibrillate using an AED (77.8% vs. 29.2%, P=0.01). There were no differences in simulation frequency or other resuscitation practices between the 2 hospital groups. Conclusions: Across hospitals caring for pediatric patients, substantial variation exists in resuscitation practices. For some resuscitation practices, there were differences between freestanding pediatric hospitals and hospitals which care for both adults and children.

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Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm11010217 ◽

2021 ◽

Vol 11 (1) ◽

pp. 217

Author(s):

Loric Stuby ◽

Laurent Jampen ◽

Julien Sierro ◽

Maxime Bergeron ◽

Erik Paus ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Controlled Trial ◽

Face Mask ◽

Airway Device ◽

Supraglottic Airway ◽

Chest Compressions ◽

The Difference ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In the i-gel® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered.

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Abstract 220: Missed Opportunity for Medical Emergency Team Activation in Pediatric In-Hospital Cardiac Arrest

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.220 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Natalie Jayaram ◽

Maya L Chan ◽

Fengming Tang ◽

Paul S Chan

Keyword(s):

Cardiac Arrest ◽

Medical Emergency Team ◽

Vital Signs ◽

National Registry ◽

Medical Emergency ◽

Missed Opportunities ◽

Emergency Team ◽

Variable Success ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background: Prior studies of Medical Emergency Teams (METs) in pediatric hospitals have shown inconsistent results in terms of their ability to improve outcomes. Whether the variable success is due to differential utilization of METs among hospitals is unknown. Methods: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children (age <18 years) with an in-hospital cardiac arrest (IHCA) on the general inpatient or telemetry floors from 2007 to 2014. In cases of IHCA where MET evaluation did not occur, we examined the frequency of “missed” opportunities for activation of the MET based upon the presence of one or more abnormal vital signs. We also examined the variability in utilization of the MET among those hospitals with at least ten cases of IHCA. Results: Of 215 children from 23 hospitals sustaining an IHCA, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to IHCA were older (6.8 ± 6.5 vs. 3.1 ± 4.7, p < 0.001) and were more likely to have metabolic/electrolyte abnormalities (9/48 [18.8%] vs. 9/167 [5.4%], p=0.006), sepsis (8/48 [16.7%] vs. 8/167 [4.8%], p=0.01), or malignancy (11/48 [22.9%] vs. 9/167 [5.4%], p<0.001) at the time of their IHCA. Hospital utilization of the MET varied substantially (median 20%; inter-quartile range [IQR]: 3.4%-29.8%; range: 0%-36.4%). Among patients who did not have a MET called prior to their IHCA, 78/141 (55.3%) had at least one abnormal vital sign that should have triggered a MET. Conclusion: In a large, national registry, we found that the majority of pediatric IHCA cases are not preceded by a MET evaluation despite meeting criteria that should have triggered a MET. Improved utilization of the MET by all hospitals could lead to fewer pediatric IHCA and improved outcomes following pediatric IHCA.

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P1705The association between pre-shock ventricular fibrillation duration and shock success during out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz748.0460 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Nas ◽

J Thannhauser ◽

P M Van Grunsven ◽

G Meinsma ◽

N Van Royen ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Chest Compression ◽

Real World ◽

Interquartile Range ◽

Chest Compressions ◽

Duration Time ◽

Hospital Cardiac Arrest

Abstract Background After the first shock, most ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) patients require subsequent shocks before organized rhythm is restored. Currently, all those shocks are given after a fixed 2 or 3-minute chest compression interval, resulting in many unsuccessful shocks. However, recently new defibrillators have been developed that can recognize VF during chest compressions, and enable earlier shocks immediately upon detection of VF. This prompts the question whether VF of shorter duration is associated with higher shock success. Purpose To study the association between pre-shock VF-duration and shock success in all subsequent shocks during OHCA. Methods Detailed VF-study on a subset of our prospective, real-world cardiac arrest-registry, focusing on patients with ≥2 shocks for VF and available ECG-tracings. These were scrutinized to determine VF-duration (time from VF-onset until shock) and shock success (return of organized rhythm within 1 min. after the shock). All first shocks were excluded. Results We studied 397 shocks from 101 patients. Of these, 77% were male and median age was 64 (interquartile range [IQR] 54–76) years. Overall shock success was 51% and survival to discharge was 19%. Overall median pre-shock VF-duration was 221s (IQR 125–433). The median pre-shock VF-duration was shorter before a successful (171s [IQR 75–295]) than before an unsuccessful shock (334s [IQR 174–740]), p<0.001. Shock success decreased from 75% in the quartile with the shortest to 21% in the quartile with the longest pre-shock VF-duration, p for trend<0.001 (Figure 1). Figure 1 Conclusion In shocks following the first defibrillation attempt, VF of shorter duration is associated with higher proportions of shock success. In an era of defibrillators that are able to recognize VF during chest compressions, our findings prompt the question whether shock upon detection of VF may improve the dismal outcomes of VF cardiac arrest. Acknowledgement/Funding None

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Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation

PLoS ONE ◽

10.1371/journal.pone.0251511 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251511

Author(s):

Jose Julio Gutiérrez ◽

Mikel Leturiondo ◽

Sofía Ruiz de Gauna ◽

Jesus María Ruiz ◽

Izaskun Azcarate ◽

...

Keyword(s):

Chest Compression ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Average Value ◽

Transthoracic Impedance ◽

Single Feature ◽

End Tidal ◽

Hospital Cardiac Arrest

Background Measurement of end-tidal CO2 (ETCO2) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO2 variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO2 during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. Methods We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO2 between consecutive ventilations was computed and its average value, ΔETavg, was used as a single feature to discriminate between ROSC and non-ROSC segments. Results A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔETavg was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. Conclusion Average percent variation of ETCO2 during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings.

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Abstract 181: Patterns of Waveform and Energy Use in Defibrillation for Cardiac Arrest: Insights from the Get With The Guidelines-Resuscitation Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.181 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Preston M Schneider ◽

Wenhui Liu ◽

Gary K Grunwald ◽

Paul S Chan ◽

Brahmajee K Nallamothu ◽

...

Keyword(s):

Cardiac Arrest ◽

Energy Use ◽

National Registry ◽

Study Cohort ◽

Chi Square ◽

Frequent Use ◽

Biphasic Waveform ◽

Chi Square Test ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background: Early defibrillation for termination of life-threatening arrhythmias is key to survival of cardiac arrest. Biphasic waveform defibrillation has been suggested as superior to monophasic waveform defibrillation, but little is known about trends in defibrillation waveform and energy used for in-hospital cardiac arrest. Methods: Within Get With The Guidelines-Resuscitation, a national registry of in-hospital cardiac arrest, we identified subjects over age 18 with an in-hospital cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia between 2005 and 2012. We restricted the study cohort to this time period, as defibrillation waveform and energy were not captured prior to 2005. We examined calendar year trends in defibrillation waveform and energy of first defibrillation attempt using the chi-square test. Results: A total of 22,108 patients from 504 facilities were identified. In 2005, in which there were 2898 in-hospital cardiac arrest cases, 1911 (66%) events were treated with biphasic defibrillation and 987 (34%) with monophasic defibrillation. By 2012, nearly all (97% [1460/1502]) events were treated with biphasic defibrillation; p for trend < 0.0001 (see Figure). For biphasic defibrillation, the predominant energy used for first defibrillation attempt was 200 J (55.91% of events) with 150 J being the next most common (18.21% of events) with a trend toward more frequent use of 200 J (p < 0.0001). Conclusion: Biphasic defibrillation at 200 J is now the predominant waveform and energy used for initial defibrillation during in-hospital cardiac arrest. Additional work is needed to determine if a rise in use of biphasic defibrillation is improving outcomes.

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Abstract 207: The Prevalence and Significance of Abnormal Vital Signs Prior to In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.207 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Won Young Kim ◽

Lars W Andersen ◽

Sharri Mortensen ◽

Maureen Chase ◽

Katherine Berg ◽

...

Keyword(s):

Cardiac Arrest ◽

Vital Sign ◽

Multivariable Analysis ◽

Vital Signs ◽

National Registry ◽

Patient Demographics ◽

Get With The Guidelines ◽

Hospital Wards ◽

Hospital Cardiac Arrest ◽

Overall Mortality

Background: The association between vital sign abnormalities prior to cardiac arrest and outcome has not been previously reported. In this study we investigated the prevalence of abnormal vital signs prior to in-hospital cardiac arrest and the association with mortality Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between 2007-2010. We included index events and excluded patients with missing data on vital signs within 1-4 hours prior to arrest. We evaluated the prevalence of abnormal vital signs classified as mild, moderate or severe (Table 1). We determined the association between the number of abnormal vital signs per patient and in-hospital mortality using multivariate logistic regression with adjustment for multiple potential confounders including patient demographics and co-morbid conditions. Results: A total of 9,560 patients were included. Median age was 71 (60 - 81) years, 42% were female and overall mortality was 77%. The prevalence of vital sign abnormalities is shown in Table 1. As illustrated in Figure 1 we found a step-wise increase in mortality with increasing number of abnormal vital signs that remained in multivariable analysis across all categories (Mild: adjusted OR 1.37 [CI: 1.27 - 1.48], Moderate: adjusted OR 1.53 [CI: 1.35 - 1.73] and Severe: adjusted OR 1.43 [CI: 1.21 - 1.70], all p-values < 0.0001). Conclusion: Abnormal vital signs are common within four hours before cardiac arrest on in-hospital wards. Our study demonstrates incremental increases in mortality with both increasing number of pre-arrest abnormal vital signs as well as increased severity.

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Abstract 350: Hospital Variation in Survival for Pediatric In-Hospital Cardiac Arrest: A Report From Get With the Guidelines -Resuscitation

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a350 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Natalie Jayaram ◽

John A Spertus ◽

Fengming Tang ◽

Paul S Chan

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

National Registry ◽

High Performing ◽

Hierarchical Logistic Regression ◽

Hospital Survival ◽

Hospital Variation ◽

C Statistic ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,640 cardiac arrests in children from 168 hospitals from 2006 to 2010. Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge. We then applied the coefficients and random hospital intercepts from the model to examine risk-standardized rates of cardiac arrest survival for those hospitals with a minimum of 10 pediatric cardiac arrest cases. Results: A total of 15 patient-level predictors were identified: age, sex, race, cardiac arrest rhythm, location and day of arrest, mechanical ventilation, baseline depression in neurological function, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, and use of intravenous antiarrhythmics or vasopressors at the time of arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 31 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 21% to 44%; range: 0% to 59%). After risk-standardization, variation in hospital survival rates persisted (median, 37%; IQR: 33% to 41%; range: 31% to 49%), although the range of outcomes narrowed considerably. Conclusion: In a large national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. Even with risk-standardization, there is significant variation in survival rates across hospitals. Leveraging these models, best practices can be assessed at high-performing hospitals and shared with others to improve care in the setting of pediatric cardiac arrest.

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Abstract 17534: The Most Appropriate Number of Personnel Needed for Chest Compressions for In-hospital Cardiac Arrest: A Randomized, Crossover Manikin Study

Circulation ◽

10.1161/circ.132.suppl_3.17534 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shunsuke Yamanaka ◽

Kei Nishiyama ◽

Hiroyuki Hayashi ◽

Ji Young Huh

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Healthcare Providers ◽

Preliminary Evaluation ◽

Chest Compressions ◽

Rescue Team ◽

Manikin Study ◽

Hospital Cardiac Arrest

Background: Effective chest compression (CC) is vital in cardiopulmonary resuscitation (CPR), and rescuer’s fatigue negatively affects quality of CPR. However, there is no consensus on the appropriate number of personnel needed for CC to avoid rescuer’s fatigue. Objective: We determined the appropriate number of personnel needed for 30-min CPR in a rescue-team in a hospital. Methods: We conducted a preliminary randomized, crossover, manikin trial on healthcare providers. We divided them into Groups A to D according to the intervals between the 2-min CC and assigned a different interval to each group. Groups A, B, C, and D performed CCs at 2-, 4-, 6-, and 8-min intervals as in 2, 3, 4, and 5 personnel, respectively. All participants performed CCs for 30 min with different intervals depending on the assigned group; participants allocated to Groups A, B, C, and D performed 8, 5, 4, and 3 cycles, respectively. We compared the differences between first cycle and the second to the last cycle Results: We enrolled 42 participants (age: 25.2±4.2, men 47.6%) for the preliminary evaluation. We used Kruskal-Wallis for the analysis. Participants in the less interval Groups A and B performed faster (A: -24.28±15.18, B: -7.90±13.49, C: -11.27±17.01, D: -2.38±3.31, P=0.03) and shallower CCs (A: -4.42±6.92, B: -3.18±5.43, C: -0.18±5.74, D: -1.23±4.10, P=0.62). Women-rescuers performed faster (A: -27.25±12.23, B: -7.00±13.97, C: -8.16±19.26, D: 3.16±4.66, P= 0.05) and shallower CCs (A: -6.25±7.54, B: -3.00±6.89, C: -3.66±3.32, D: -0.16±4.35, P=0.58). However, CCs of men-rescuers were not faster (A: -20.33±20.65, B: -9.00±14.44, C: -15.00±15.11, D: -7.14±16.70, P= 0.60) or shallower (A: -2.00±6.55 B: -3.40±3.78, C: 4.00±5.33, D: -2.14±3.98, P=0.06). Conclusion: At least four rescuers (Group C) may be needed to reduce rescuer’s fatigue for 30-min CPR. If the team only includes women, more personnel would be needed as women experience fatigue faster.

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Abstract 108: Pulselessness Despite Cardiopulmonary Resuscitation for Bradycardia in Hospitalized Children: Prevalence, Predictors of Survival, and Implications for Hospital Profiling

Circulation ◽

10.1161/circ.138.suppl_2.108 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Rohan Khera ◽

Yuanyuan Tang ◽

Saket Girotra ◽

Vinay M Nadkarni ◽

Mark S Link ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Pediatric Patients ◽

Independent Predictor ◽

Care Delivery ◽

Hospital Performance ◽

Hospitalized Children ◽

Entire Cohort ◽

Get With The Guidelines ◽

Hospital Profiling ◽

Hospital Cardiac Arrest

Background: Cardiopulmonary resuscitation (CPR) is initiated in hospitalized children with bradycardia and poor perfusion. However, it is unknown how often these children progress to pulseless in-hospital cardiac arrest (IHCA) despite CPR, and whether survival differs from primary pulseless IHCA. Methods: In Get With The Guidelines-Resuscitation (2000-2016), we identified all pediatric patients (age>30 days, <18 years) receiving CPR, and assessed the prevalence and predictors of survival among those progressing from bradycardia to pulselessness after initiation of CPR using multilevel Poisson regression that accounted for the pulseless rhythm. Results: Overall, 5592 pediatric patients were treated with CPR, of whom over half (2799) were for bradycardia with poor perfusion and the remaining 2793 were primary pulseless IHCAs. Among those with bradycardia, 869 (31%, or 16% of entire cohort) progressed to pulselessness after a median of 3 min of CPR (IQR 1- 9). Survival to discharge was 70% for bradycardia without pulselessness, 30% with bradycardia progressing to pulselessness, and 38% with primary pulseless IHCA (P<.001). Children who became pulseless while receiving CPR for bradycardia had a 19% lower likelihood (RR 0.81 [0.70 - 0.93]) of surviving to hospital discharge than those initially pulseless. Among children who progressed to pulselessness while receiving CPR for bradycardia, longer time to pulselessness was an independent predictor of lower survival (ref: <2 min, for 2-5 min: RR 0.54 [0.41 - 0.70]; for >5 min: RR 0.41 [0.32 - 0.53], Figure ). Conclusions: Among non-neonatal pediatric patients in whom CPR is initiated, half have bradycardia with poor perfusion, and nearly one-third of these progress to IHCA despite CPR. Survival was lower for pediatric patients who subsequently became pulseless as compared to those who were initially pulseless. These findings have implications for care delivery and profiling hospital performance for pediatric IHCA.

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Non-Pediatric Nurses’ Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.3 ◽

2021 ◽

pp. 1-6

Author(s):

Terri Rebmann ◽

Rachel L. Charney ◽

Rebecca L. Eschmann ◽

M. Colleen Fitzpatrick

Keyword(s):

Pediatric Patients ◽

Response Rate ◽

Mass Casualty ◽

Pediatric Care ◽

Pediatric Nurses ◽

Surge Capacity ◽

Factors Associated ◽

Pediatric Hospitals ◽

Survey Response Rate ◽

Mass Casualty Event

Abstract Objective: To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE). Methods: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care. Results: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. Conclusion: Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

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