Venessa Pinto, MD
Assistant Professor
Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Kelli Irwin, DNP
Pediatric Nurse Practitioner
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Katherine Lemming
Clinical Pharmacy Specialist
Texas Childrens Hospital, United States
Disclosure information not submitted.
.jpg "Jamie Causey, MD photo")
Jamie Causey, MD
CVICU
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Jennifer Erklauer, MD
Assistant Professor
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Aarti Bavare, MD, MPH
Associate Professor
Texas Childrens Hospital, United States
Disclosure information not submitted.
Saul Flores, MD
Associate Professor
Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Jordana Goldman, MD
Assitant Professor
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Matthew Musick, MD
Assistant Professor
Texas Children's Hospital-Baylor College of Medicine, United States
Disclosure information not submitted.
Cameron Dezfulian, MD
Associate Professor of Medicine
Baylor College of Medicine
Houston, Texas
Disclosure information not submitted.
Javier Lasa, BS, MD, FAAP
Associate Professor
Texas Childrens Hospital, United States
Disclosure information not submitted.
Title:Development of Post-Cardiac Arrest Care Guidelines Across a Quaternary Pediatric Health System
Introduction: Standardizing the care of children and adults after cardiac arrest has been addressed by the American Heart Association (AHA) and enforced by new Joint Commission requirements yet few reports describe the process of adoption and implementation across large multi-campus hospital systems. We describe our experience adapting and implementing the recently published evidence-based/ expert consensus guidelines for post-cardiac arrest care (PCAC) across a complex pediatric healthcare system that includes 3 campuses with multiple med-surg pediatric ICUs, cardiac ICU, adult congenital heart ICU, and adult obstetrical ICU.
Methods: A multi-disciplinary taskforce was created to oversee development, stakeholder engagement, education, and implementation of PCAC guidelines for both pediatric and adult populations. Local content experts in resuscitation science undertook a comprehensive literature review to ensure guidelines were evidence-based and aligned with AHA recommendations. Quality improvement methodology was used to create a SMART aim, and to identify outcome, process and balancing measures a priori. Institutional information technology and electronic medical records teams aided with data collection and order set and flowsheet creation.
Results: We experienced challenges in consensus building primarily related to neuromonitoring and targeted temperature management in the pediatric population. A comprehensive PCAC guideline for both pediatric and adult populations was ultimately developed with recommendations on hemodynamic and neurological monitoring, diagnostic testing, and the option of normothermia or hypothermia for pediatric patients. Barriers to implementation were identified early and included limitations in pre-hospital/transport monitoring technology, cooling devices, as well as variability in resources across campuses, such as continuous EEG monitoring and advanced resuscitation capabilities (E-CPR).
Conclusions: Unique logistical, clinical, and organizational challenges can be encountered when implementing institution-wide, pediatric and adult PCAC guidelines. With a commitment to the highest standards of evidence-based care, maintaining uniform standards of practice, and collaboration, it is feasible to develop and implement PCAC guidelines across a large complex pediatric healthcare system.