Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study*

Objectives:
Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes.
Design:
Single-center retrospective before-after study.
Setting:
Academic PICU.
Patients:
Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation.
Intervention:
Deployment of a postcardiac arrest clinical pathway and computerized order entry system.
Measurements and Main Results:
There were 380 patients included—163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0–6 and 6–24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significantly different be...

Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research