Cardiac Intensivist Johns Hopkins All Children’s Hospital Tampa, Florida, United States
Abstract: Introduction/Objective Pediatric patients with congenital or acquired heart disease are at high risk for in-hospital cardiac arrest (CA) resulting in significant morbidity and mortality. The Cardiac Arrest Prevention (CAP) bundle developed by the Pediatric Critical Care Consortium (PC4) has been adopted by many CICUs including our own. This study evaluated the utilization and the cost savings associated with a customized cardiac arrest medication kit (CAMK) that included patient specific rescue medications of atropine, epinephrine, calcium chloride, and sodium bicarbonate.
Methods We implemented the CAP bundle as part of the in-hospital cardiac arrest prevention strategy in a 22-bed tertiary care CICU academic hospital. All medical and surgical patients age 0-21yrs admitted to the CICU from May 1, 2021 onwards identified as candidates for the CAP bundle had a customized CAMK prepared by the inpatient pharmacy. The kit included patient specific rescue medication of atropine, epinephrine, calcium chloride, and sodium bicarbonate. We retrospectively reviewed the utilization of the CAMK and the cost associated with the complex kits in these patients.
Results From May 1, 2021, to March 31, 2022, there were 305 CICU encounters. A total of 26 patients had a CAP bundle implemented and 62 CAMKs were ordered of which only 5(8%) were utilized. In all five occurrences epinephrine was the only medication utilized to prevent impending cardiac arrest. Calcium Chloride was used infrequently, however the administration was outside the CAP parameters. The cost of the CAMK to the hospital was determined to be $15,127.32 per 100 CAP bundle orders. Due to the low utilization of the CAMK, and specifically with epinephrine being the only utilized medication, we determined that ordering dilute epinephrine at bedside rather than an entire customized CAMK would be sufficient. The cost saving associated with this change would amount to $14,478.32 per 100 CAP bundle orders.
Conclusions Cardiac arrest medication kits at the bedside are useful in the event of a cardiac arrest. However the cost of a customized kit was substantial in our unit when compared to the actual utilization. Streamlining bedside medications for cardiac arrest prevention can have a significant cost savings in a CICU with low CAP medication use.
