The ICU-Resuscitation Project (ICU-RESUS)

Pediatric cardiac arrest affects thousands of hospitalized children each year. Progressive
heart and lung failure is a predisposing cause in the majority of these events. While cardiac
arrest survival outcomes have improved over the last decade, more than half of these children
will not live to hospital discharge. As brain injury complicates care in those who do
survive, the burden to these children and the public's health is substantial.

Cardiopulmonary resuscitation (CPR) - the medical procedure of providing chest compressions
and ventilations during cardiac arrest - is life saving, and higher quality CPR is more
effective at doing so. However, providing high quality care during the resuscitation of a
child is difficult. Attempts to improve care through conventional training methods have not
been successful; therefore, interventions to improve the quality of pediatric CPR and
outcomes are needed.

The objective of this study is to determine if a novel resuscitation care improvement bundle
that improved outcomes in a single center intensive care unit (ICU) efficacy study is
generalizable to other pediatric institutions in a multi-center effectiveness trial. The
ICU-Resuscitation (ICU-RESUS) bundle includes: 1) CPR training at the point-of-care (in the
ICU rather than a classroom away from patients); and 2) interdisciplinary structured reviews
of each cardiac arrest that emphasize patient-centric physiology intended to optimize
intra-arrest and post-arrest care. The ICU-RESUS bundle substantially improved CPR quality
and nearly doubled the number of children surviving their event during the single center
efficacy trial. In this study, a multi-institutional parallel stepped-wedge hybrid
cluster-randomized trial, which leverages the existing infrastructure of the National
Institute of Child Health and Human Development (NICHD)-funded Collaborative Pediatric
Critical Care Research Network (CPCCRN), is proposed with the following aims: 1) Evaluate the
effectiveness of the ICU-RESUS interventional bundle to improve outcomes of children treated
for an ICU cardiac arrest; and 2) Evaluate the effectiveness of the ICU-RESUS interventional
bundle to improve the quality of CPR provided by ICU healthcare providers in the population
of children treated for an ICU cardiac arrest.

Inclusion Criteria:

- Age greater than or equal to 37 weeks and less than or equal to18 years of age;

- AND Received CPR in the ICU setting

Exclusion Criteria:

- Pre-existing terminal illness and patient not expected to survive to hospital
discharge.

- Lack of commitment to aggressive ICU therapies.

- Brain death determination prior to CPR event.

- First CPR event associated with this hospital admission was an out-of-hospital CPR
event.