When the Code Blue is Real: Outcomes and Characteristics of Non-ICU Cardiac Arrests Attended by a Critical Care Response Team (CCRT)
CCCF ePoster library. Rassameehirum C. Oct 3, 2017; 198116; 46
Chavisa Rassameehirum
Chavisa Rassameehirum
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When the Code Blue is Real: Outcomes and Characteristics of Non-ICU Cardiac Arrests Attended by a Critical Care Response Team (CCRT)

Rassameehirun, Chavisa; Zoica, Bogdana; Annich, Gail; Michael-Alice, Moga

Department of Pediatric critical care medicine, The hospital for Sick Children, University of Toronto, Toronto, Canada

INTRODUCTION Cardiopulmonary arrest (CPA) in hospitalized children continues to be associated with significant morbidity and mortality.  CPAs are increasingly confined to specialized areas (ICU, OR, ED), however, events outside these areas still occur.  This subset of inhospital cardiac arrests requires further clarification to identify at-risk patients, improve outcomes and allow for enhance preventability and prediction assessment.
OBJECTIVES Define the patient population and event characteristics throughout the continuum of care for all CPAs attended by CCRT at a large, tertiary care children’s hospital.
METHODS We conducted a retrospective chart review (electronic chart and code blue reviews) of all children (<18yo) suffering from a CPA handled through the hospitalwide Code Blue (CB) system at the Hospital for Sick Children from 2007-2015.  CPAs not run by the Code Blue team were excluded. The primary outcomes were patient and event characteristics. The secondary outcomes were peri-arrest care and patient outcomes.  Standard descriptive statistics were utilized.
RESULTS From 2007-2015, 126 CPAs requiring CB activation occurred in 120 patients. The majority of patients were male (58%) and the mean age was 39months (SD 63 months).  A large proportion of patients suffered CPA while recovering from cardiac surgery (41%).  Half of the CPAs occurred in patients with known cardiac failure and one third of arrests occurred on the cardiology ward. Other common preexisting comorbidities include genetic disease (25%) and hematology/oncology disease (11%).  Most patients (60%) had low bedside pediatric early warning score (<7) and were on intermittent or continuous monitoring at the time of arrest (86%).  The CCRT team was actively involved in only 35% of the patients’ care leading up to CPA.  Most arrests occurred in off hours (7pm-7am, holidays or weekends) and accounted for a larger proportion of Code Blue activations during those time periods. CPA were primarily respiratory in nature with an initial recorded rhythm of asystole/PEA or bradycardia. The vast majority of patients (87%) regained circulation.  Three-fourths of patients were transferred to the ICU; 21% of those patients received E-CPR.  The rate of ICU and hospital survival were 68% and 57%, respectively.
CONCLUSIONS CPA in pediatric patients outside the ICU is neither common, nor completely rare.  Children with cardiac disease represent a high-risk population. Despite encouraging initial outcomes, there is significant attrition to hospital discharge. This data informs ongoing analysis of factors associated with poor patient outcomes and potential preventability of CPA.  Further characterization will inform outcome prediction and enhance development of protocols/systems to aid in preventability and treatment.

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