University of Alabama at Birmingham, United States
Abstract: Introduction A Cardiac Arrest Prevention Bundle (CAP) is known to decrease in-hospital cardiac arrests (IHCA) in the pediatric CICU. CAP includes identification of patients at high risk of CA, a patient specific dose of epinephrine drawn up and at the bedside for rapid delivery, and a safety huddle at the bedside for situational awareness and just-in-time training of a mitigation plan to reverse or rescue a patient from CA. The American Heart Association (AHA) updated its guidelines in 2020 to include early delivery of epinephrine to improve CA outcomes. The objective of this study is to analyze time to administration of first dose of epinephrine during CA and compare outcomes in patients on CAP bundle vs no CAP bundle. Methods Prospective data collection of all CA from January 2018-December 2021 at a single center cardiac intensive care unit. All data extracted from EMR, code sheet and code participant interviews. Time to epinephrine is defined as time from initiation of chest compressions (CC) until first dose. Results There was a total of 89 CA in the study period. 26 (26.9%) patients were on CAP bundle and 63 (70.8%) were not. Table 1 shows pre-arrest characteristics and post-arrest outcomes. Median age for CAP bundle patients was lower but not significant. There was no difference in type of encounter or single ventricle status. More CAP bundle patients were mechanically ventilated, had arterial lines, and had higher vasoactive inotrope scores as expected. Those on CAP were more likely to get epinephrine (92% vs 82.5%) and have a shorter time to receive first dose of epinephrine (1 vs 1.5 minutes, p=0.03). The median duration of CC was not statistically significant, nor was hospital survival although there was higher survival in the CAP bundle cohort (76.9% vs 69.8%). When adding patients (n=16) who had epinephrine prepared at the bedside but who did not had the whole bundle activated to the CAP group, the median difference increased to 1min [1min (0.5, 2) vs. 2min (1, 3), p=0.021) highlighting the significance of this important finding. Conclusion When a patient has IHCA, early epinephrine is an important AHA guideline to improve post CA outcomes. Having a CAP bundle with special attention to a patient specific dose of epinephrine is associated with a faster median time to first dose of epinephrine delivery when compared to patients not on a CAP bundle. Mortality was not different despite significant differences at time of CA. More research is needed to address the benefits of different elements of CAP and how to expand it to more patients.
