Erin Platter
University of Virginia School of Medicine
Charlottesville, VA
Disclosure information not submitted.
Laura Lee, MD
Associate Professor
University of Virginia, United States
Disclosure information not submitted.
Title: Spontaneous mock code program to improve quality of cardiopulmonary resuscitation on pediatric floor
Introduction: Outcomes of in-hospital pediatric cardiopulmonary arrests are suboptimal with large inter-hospital variability suggesting that resuscitation quality affects outcomes. At our institution, the nursing, physician, and respiratory therapy providers staffing the pediatric acute care wards identified poor code readiness, anxiety with resuscitations, and discomfort with Pediatric Advanced Life Support (PALS) as areas for improvement. To address these concerns, we implemented a spontaneous mock code program on the pediatric acute care wards with the goals of improving: 1) the speed of initiation of basic life support; 2) the quality of cardiopulmonary resuscitation (CPR) using ZOLL (Zoll Medical Corporation, Chelmsford, MA) defibrillator monitoring; and 3) the speed and appropriate administration of epinephrine.
Methods: From August 2020 to May 2021 we completed nine spontaneous mock codes. Mock code scenarios were initiated at random on the pediatric wards using three basic cardiopulmonary arrest scenarios: respiratory arrest, sepsis and ventricular tachycardic arrest. Each code was evaluated by two independent observers in real time and reported times are an average of those observations.
Results: CPR was initiated within 90 seconds for all mock codes and code team response times were within 3 minutes. Epinephrine administration times ranged from 5.5 minutes to 10 minutes, never within 5 minutes as recommended by new PALS guidelines. End-tidal carbon dioxide monitoring was not initiated for any of the nine mock codes, although available in our institution with ZOLL defibrillator monitoring. ZOLL pads were attached between 3 to 8 minutes after arrest, and defibrillation during the two ventricular tachycardic arrest scenarios occurred within 15 minutes.
Conclusions: After analysis of mock code data, areas of excellence were identified as quick initiation of basic life support with appropriate ratio of compressions to breaths, and suitable code team response times. Areas for improvement were identified as epinephrine administration, end-tidal carbon dioxide monitoring and overall knowledge and comfort with the ZOLL defibrillator. We plan to initiate more consistent monthly spontaneous mock codes with emphasized education on ZOLL defibrillator use, and implement a work flow for epinephrine administration.