Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Erin F Hoehn; Preston Dean; Andrew J Lautz; Mary Frey; Mary K Cabrera-Thurman; Gary L Geis; Erika Stalets; Matthew Zackoff; Tena Pham; Andrea Maxwell; Adam Vukovic; Benjamin T Kerrey

doi:10.1097/pq9.0000000000000365

Peri-Intubation Cardiac Arrest in the Pediatric Emergency Department: A Novel System of Care

Pediatr Qual Saf. 2020 Oct 26;5(6):e365. doi: 10.1097/pq9.0000000000000365. eCollection 2020 Nov-Dec.

Authors

Erin F Hoehn^{1

2

3}, Preston Dean^{1

3}, Andrew J Lautz^{3

4}, Mary Frey¹, Mary K Cabrera-Thurman⁵, Gary L Geis^{1

3}, Erika Stalets^{3

4}, Matthew Zackoff^{3

4}, Tena Pham⁴, Andrea Maxwell⁴, Adam Vukovic^{1

3}, Benjamin T Kerrey^{1

3}

Affiliations

¹ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
² Children's Hospital of Pittsburgh of UPMC, Division of Emergency Medicine, Pittsburgh, Pa.
³ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁴ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁵ Emergency Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Abstract

Patients with physiologic disorders, such as hypoxemia or hypotension, are at high risk of peri-intubation cardiac arrest. Standardization improves emergency tracheal intubation safety, but no published reports describe initiatives to reduce the risk of cardiac arrest. This initiative aims to improve the care of children at risk of peri-intubation cardiac arrest in a pediatric emergency department (PED). We specifically aimed to increase the number of patients between those with peri-intubation cardiac arrest by 50%, from a baseline of 11-16, over 12-months.

Methods: Our multidisciplinary team outlined a theory of improvement and designed interventions aimed at key drivers. The primary intervention was creating a PICU-ED Team (PET) and a checklist to guide the assessment and mitigation of risk for peri-intubation arrest and rapid consultation of the pediatric intensivists. The PET was iteratively refined, and we collected data by a video review of tracheal intubations.

Results: Fifty-one patients with risk factors for peri-intubation arrest underwent tracheal -intubation in the PED from January 2016 to March 2020: 14 with PET activation since PET go-live in April 2019. None of the 14 PET patients had a peri-intubation cardiac arrest. Ninety-three percent (13/14) of PET patients were intubated in the PED, and 78% (10/13) of these patients had the first intubation attempt completed by PED physicians (balancing measures).

Conclusion: We successfully developed the PET to mitigate the risk of peri-intubation cardiac arrest without significantly reducing key procedural opportunities for the PED. Initial data are promising, but further refinement is needed.