Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes

Cardiac arrest is a major public health problem with 200,000 in-hospital cardiac arrest resuscitations each year in the United States (1, 2). Importantly, quality of cardiopulmonary resuscitation (CPR) performed during resuscitations frequently does not meet recommended guidelines (3–5). In addition, wide variability in duration of resuscitations and survival outcomes further suggest opportunities for improvement (6). Because CPR quality is associated with survival (4, 7–10), interventions to improve quality of CPR are a promising method to improve cardiac arrest outcomes. Approaches to improve CPR quality include standard resuscitation courses, automated real-time corrective feedback devices, and structured postresuscitation debriefing. Although standard courses are the mainstay of ongoing life support training and maintenance of certification, evidence that courses improve outcomes is modest (11–13). Automated real-time corrective feedback devices incorporated into monitor-defibrillator systems have been moderately effective to improve psychomotor aspects of basic life support (i.e., chest compressions [CCs] and ventilation delivery) (14, 15), yet data demonstrating improved long-term outcomes are limited (16). Structured postresuscitation debriefing is a comprehensive review of resuscitation efforts, including quantitative review of CPR variables. Interestingly, structured postresuscitation debriefing for physicians who were involved in resuscitations has been effective at improving CPR quality and short-term survival; however, its implementation has not been associated with higher rates of survival to hospital discharge or survival with favorable neurologic outcome (17). To improve resuscitation performance by the entire resuscitation team, we developed a novel interdisciplinary, care-environment–targeted, postevent quantitative cardiac arrest debriefing program (18). Because over 90% of pediatric in-hospital cardiac arrests occur in ICUs (19), we focused our efforts on the interdisciplinary ICU team including physicians, nurses, and respiratory therapists. In a prospective quality improvement intervention, we compared quantitative resuscitation quality and patient outcomes before and after implementation of this novel postarrest quantitative debriefing program. We hypothesized that our intervention, by improving the resuscitative care provided by the entire interdisciplinary team, would improve cardiac arrest survival outcome.