This document proposes a study to evaluate a bundled intervention to improve outcomes from pediatric cardiac arrest. The intervention includes (a) an American Heart Association Resuscitation Quality Improvement program, (b) simulation cardiac arrest training with post-event CPR debriefing, and (c) use of real-time CPR feedback during real cardiac arrests. The study would use a single group pre-post test design to evaluate the impact of this bundled intervention on CPR performance during training, simulations, real events, and rates of return of spontaneous circulation in real patients. Key aspects of the proposed study design that require further consideration are the length of each study phase, whether to conduct debriefing after simulations and real events, how many simulations

1. A Bundled Intervention to Improve
Outcomes from Pediatric Cardiac Arrest
Adam Cheng (University of Calgary), Vinay Nadkarni (CHOP)
INSPIRE @ IMSH 2014: San Francisco, California,USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background
• Outcomes from cardiac arrest are poor
• Several interventions (used in isolation) have been
shown to improve performance of CPR
– Use of real-time CPR feedback devices
– Post-arrest debriefing with quantitative CPR data
– Distributed CPR training (rolling refreshers)
• No studies combining these interventions and
evaluating impact on real patient outcomes
International Network for Simulation-based Pediatric Innovation, Research and Education

3. PICO Question
• P: For pediatric intensive care unit healthcare providers
• I: Does the implementation of a bundled intervention including:
(a) AHA RQI program; (b) simulation cardiac arrest program with
post-event CPR debriefing; and (c) use of real-time CPR
feedback during real events
• C: Current practice
• O: Improve quality of CPR during practice, simulated events,
real events, and ROSC in real patients?
International Network for Simulation-based Pediatric Innovation, Research and Education

4. Approach / Design
• Single group pre/post study
• Subjects: pediatric ICU providers (individuals and
teams)
– Attendings, fellows, residents, nurses, RT’s
• Phase 1: Baseline data capture
• Phase 2: Intervention phase
• Phase 3: Assessment phase
International Network for Simulation-based Pediatric Innovation, Research and Education

5. Design: Outcomes
• Performance of CPR during practice
• Performance of CPR during simulated events
• Performance of CPR during real events
• Outcomes from cardiac arrest: ROSC
International Network for Simulation-based Pediatric Innovation, Research and Education

6. Questions
• How long should each phase be?
• Should debriefing occur for simulated events and real
events?
• How many simulated events should be done per month?
• Multi-center?
International Network for Simulation-based Pediatric Innovation, Research and Education

7. Contact Information
Name:
Adam Cheng
Institution:
Alberta Children’s Hospital (KidSIM)
E-mail:
chenger@me.com
Phone:
+1-403-955-2633
International Network for Simulation-based Pediatric Innovation, Research and Education