Thread by @MGaies

Today is an exciting day for @pc4quality and @CardiacUnited

We are pleased to share results of our Cardiac Arrest Prevention (CAP) project in @JAMAPediatrics by @bubblesdadee (Jeffrey Alten) #PedsCICU #PedsICU #CHD #CardiacArrestPrevention

Link: jamanetwork.com/journals/jamap…
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It all started with a conversation among the PC4 exec committee many moons ago: What do we want to change about #PedsCICU practice? We proposed cardiac arrest because we thought that preventing CA fundamentally defines excellent CICU care.

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There was skepticism. Many smart people thought this wasn't possible. Many thought we should try something easier for our first major quality improvement project and get a sure win. Ultimately, we got buy-in to move forward with this CAP project.

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Two things happened simultaneously to launch the intervention:

1. We studied the epidemiology of CA in pediatric CICUs and recognized wide variation in incidence across @pc4quality hospitals: pubmed.ncbi.nlm.nih.gov/28737598/

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2. Dr. Alten showed data on a successful single center intervention focused on #CardiacArrestPrevention @ChildrensAL. Doing the simple stuff worked! This became our model for a multi-center intervention.

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Multidisciplinary leaders came together to develop a low-cost, low-tech CAP bundle. @CardiacUnited QI specialists provided expert coaching and implementation support. Clinical champions and countless others dove into this intervention and made it part of their unit culture.

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The brief results (read the whole paper!):
30% relative risk reduction in CA incidence over 18 months. Control hospitals (those in PC4 that did not implement CAP) demonstrated no significant change over the same period.

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Important questions remain:
1. Why didn't mortality decline over the same period at CAP hospitals?
2. What were the most important elements of the bundle?
3. Can this bundle help reduce CA rates only at hospitals with a high baseline?

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Here's what I think are the most important take home points from the study:
1. CA is not a "cost of doing business." CA is not inevitable in the #PedsCICU. We have agency over this complication.

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2. The simple things - communicating what you are thinking, creating a shared mental model across the team, being strict and explicit about vital sign ranges you tolerate - are critical to CAP, and everything else in the ICU. Discipline to do them over and over matters.

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3. Collaborative learning remains undefeated. This study represents the culmination of the vision that started @pc4quality: collect data to gain insight, learn from high performers, share and work collaboratively to change practice. Rinse, repeat.

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There are far too many people to mention who made this and all of the work by @pc4quality and @CardiacUnited possible, but a special thanks to those who've given financial support: @TheCHF castinncatchin.org, @OvercomeCHD as well as @MottChildren @CincyKidsHeart

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There will be more to come from this study team: sustainability, qualitative study on implementation, understanding interhospital variability, and analysis of secondary clinical outcomes. I hope the larger #PedsICU and adult ICU communities adopt CAP in some form.

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We were intentional about describing our work and providing resources to supplement the manuscript so that readers could implement CAP in their units as quickly as possible. Please reach out to @bubblesdadee, me, or any of the other clinical investigators to learn more.

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