Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: Study protocol for a randomized controlled trial

and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology. Methods/design: This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period. Discussion: To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14%). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives.

Original languageEnglish (US)
Article number213
JournalTrials
Volume19
Issue number1
DOIs
StatePublished - Apr 3 2018

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Cardiopulmonary Resuscitation
Heart Arrest
Resuscitation
Randomized Controlled Trials
Pediatrics
Point-of-Care Systems
Pediatric Intensive Care Units
Control Groups
Quality Improvement
Nervous System
Intensive Care Units
Survival Rate
Outcome Assessment (Health Care)
Guidelines
Education
Survival

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) (2018). Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: Study protocol for a randomized controlled trial. Trials, 19(1), [213]. https://doi.org/10.1186/s13063-018-2590-y
and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). / Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project : Study protocol for a randomized controlled trial. In: Trials. 2018 ; Vol. 19, No. 1.
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title = "Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: Study protocol for a randomized controlled trial",
abstract = "Background: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology. Methods/design: This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period. Discussion: To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14{\%}). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives.",
author = "{and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)} and Reeder, {Ron W.} and Alan Girling and Heather Wolfe and Richard Holubkov and Berg, {Robert A.} and Naim, {Maryam Y.} and Meert, {Kathleen L.} and Bradley Tilford and Carcillo, {Joseph A.} and Melinda Hamilton and Matthew Bochkoris and Mark Hall and Tensing Maa and Yates, {Andrew R.} and Anil Sapru and Robert Kelly and Myke Federman and {Michael Dean}, J. and McQuillen, {Patrick S.} and Deborah Franzon and Pollack, {Murray M.} and Ashley Siems and John Diddle and Wessel, {David L.} and Mourani, {Peter M.} and Carleen Zebuhr and Robert Bishop and Stuart Friess and Candice Burns and Shirley Viteri and Hehir, {David A.} and {Whitney Coleman}, R. and Jenkins, {Tammara L.} and Notterman, {Daniel A.} and Tamburro, {Robert F.} and Robert Tamburro",
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and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) 2018, 'Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: Study protocol for a randomized controlled trial', Trials, vol. 19, no. 1, 213. https://doi.org/10.1186/s13063-018-2590-y

Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project : Study protocol for a randomized controlled trial. / and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN).

In: Trials, Vol. 19, No. 1, 213, 03.04.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project

T2 - Study protocol for a randomized controlled trial

AU - and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)

AU - Reeder, Ron W.

AU - Girling, Alan

AU - Wolfe, Heather

AU - Holubkov, Richard

AU - Berg, Robert A.

AU - Naim, Maryam Y.

AU - Meert, Kathleen L.

AU - Tilford, Bradley

AU - Carcillo, Joseph A.

AU - Hamilton, Melinda

AU - Bochkoris, Matthew

AU - Hall, Mark

AU - Maa, Tensing

AU - Yates, Andrew R.

AU - Sapru, Anil

AU - Kelly, Robert

AU - Federman, Myke

AU - Michael Dean, J.

AU - McQuillen, Patrick S.

AU - Franzon, Deborah

AU - Pollack, Murray M.

AU - Siems, Ashley

AU - Diddle, John

AU - Wessel, David L.

AU - Mourani, Peter M.

AU - Zebuhr, Carleen

AU - Bishop, Robert

AU - Friess, Stuart

AU - Burns, Candice

AU - Viteri, Shirley

AU - Hehir, David A.

AU - Whitney Coleman, R.

AU - Jenkins, Tammara L.

AU - Notterman, Daniel A.

AU - Tamburro, Robert F.

AU - Tamburro, Robert

PY - 2018/4/3

Y1 - 2018/4/3

N2 - Background: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology. Methods/design: This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period. Discussion: To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14%). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives.

AB - Background: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology. Methods/design: This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period. Discussion: To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14%). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives.

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and for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN). Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: Study protocol for a randomized controlled trial. Trials. 2018 Apr 3;19(1). 213. https://doi.org/10.1186/s13063-018-2590-y