Editor’s Note: Dr. Morgan Irwin-Weyant is a pediatric resident. She plans to pursue a career in pediatric emergency medicine, so writing this blog was right up her alley!
-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
In the emergency department (ED), anticipation permeates through the air as soon as we hear the report from emergency medical services: a 4-month-old was found not breathing by the mother, and cardiopulmonary resuscitation is already underway, with just 5 minutes until arrival.
As soon as the patient arrives, the resuscitation bay becomes a whirlwind of activity, but how can we best organize this chaos to maximize this patient’s chance for survival?
Pediatric out-of-hospital cardiac arrest (OHCA) is a rare event, occurring in 8 per 100,000 person-years; however, with a mortality rate of over 90%, the task of improving outcomes seems daunting. Yet Dr. Anne P. Runkle and her colleagues at Cincinnati Children’s Hospital and Rainbow Babies and Children’s Hospital sought to do just that, by breaking down the process into component parts and ensuring that each team member performed their part with speed and skill (10.1542/peds.2021-055462).
In this single-center quality improvement initiative, which is being early released this week in Pediatrics, the authors aimed to reduce the total time to completion of 5 tasks in the resuscitation of patients with OHCA from 300 seconds to 120 seconds:
- Intravenous or intraosseous catheter access
- Epinephrine administration
- Advanced airway placement
- End-tidal capnography application
- Cardiac rhythm verbalization
To do this, authors assigned these responsibilities to specific individuals involved in the care of the patient in a systematic way; for example, the nurse or ED fellow on the patient’s right side would always place the right tibial intraosseous line. They then provided targeted education, supplemented with skills checkoffs and simulations. To ensure continual learning, authors provided both instantaneous and delayed feedback to the resuscitation team.
The team used audio and video recordings of OHCA resuscitation to measure the time required to complete the 5 tasks. While they did not meet their original goal of 120 seconds, the team was able to halve their baseline time, which is a commendable improvement, particularly over the course of 2 years, fraught with COVID-19 related restrictions on simulations and other opportunities for education that had originally been planned.
These findings demonstrate the influence that well-defined roles can have during a resuscitation, when each precious second affects patient outcomes. Read more in the article, which just might help you save a life.