“ We not only had to reorganize the physical structure of our trauma rooms ,” says Dr . Neubrand . “ We had to reorganize the personnel structures required to care for critically ill patients . How do we don and doff , limit people in the room , communicate with people outside the room ?”
Nevertheless , from the initial spike in early 2020 through the many spikes , plateaus and dips since , the pandemic has failed to make a dent in the team ’ s ROSC rates .
Resuscitation is a team sport ,” Dr . Neubrand notes . “ We ’ ve worked hard to make sure our teams have the tools to perform consistently at a high level , and that ’ s been incredibly important for our morale as we ’ ve weathered multiple rounds of COVID surges .”
The work continues . Even with rehearsal , cardiac events are chaotic and difficult to review objectively ; Dr . Neubrand and her team are part of the Videography in Pediatric Emergency Research ( or VIPER ) Collective , dedicated to establishing a validated model of video review for resuscitation events in pediatric emergency departments ( 4 ). So far , that collective includes Cincinnati Children ’ s Hospital , Children ’ s National Medical Center and Children ’ s Hospital of Philadelphia . Over time , their work may yield insights that could improve outcomes even more .
effect and implement change ,” says Dr . Neubrand . “ The result has been not only a vast improvement in outcomes , but improvements in emergency medical tech and nurse satisfaction , resiliency , ability to understand codes , all sorts of things .”
One of the first recruits was pediatric nurse Stacey Coss , RN , MSN , who helped to build communication practices into the simulations . They ’ ve since expanded the model from Anschutz Medical Campus to all four emergency rooms within Children ’ s Colorado ’ s System of Care .
Of course , the model works best for in-hospital cardiac arrest , where the team can immediately take their positions and jump into action . When a patient shows up with no known medical history and may have been in cardiac arrest for 20 minutes beforehand , good outcomes are exponentially more difficult to achieve .
Even then the team posts comparatively stellar ROSC rates . Nationally it ’ s around 10 %. Children ’ s Colorado ’ s rate is 23 %.
HUMAN FACTORS AND COMPLICATIONS
The COVID-19 pandemic changed the way hospitals operate , and emergency departments were no exception . In fact , in many ways , nowhere have the effects been more pronounced .
“ The innovative thing is the simplicity of it ,” says Dr . Neubrand . “ It took a lot of work and buy-in from staff , and it ’ s something we need to do consistently , but it ’ s given us a built-in platform to take those needed process changes and implement them quickly , and that makes us nimble and responsive to change .” •
1 . Miraglia D ; Cardiopulmonary resuscitation and risk of transmission of acute respiratory infections to rescuers : a systematic review snapshot . J Emerg Crit Care Med 2021 ; 5:17 .
2 . Donoghue AJ , Abella BS , Merchant R , Praestgaard A , Topjian A , Berg R , Nadkarni V ; American Heart Association ’ s Get With the Guidelines- Resuscitation Investigators . Cardiopulmonary resuscitation for in-hospital events in the emergency department : A comparison of adult and pediatric outcomes and care processes . Resuscitation . 2015 Jul ; 92:94-100 .
3 . Neubrand T , Cabrera N , Coss S , Watkins A , DiStefano M . Pushing Hard : The Mandate to Improve Care of Pediatric Cardiopulmonary Arrest . Acad Emerg Med . 2019 Jan ; 26 ( 1 ): 117-119 .
4 . Kerrey BT , OʼConnell KJ , Myers SR , Rinderknecht AS , Frey ME , Dyas JR , Boyd S , Mak AL , Cochrane N , Donoghue AJ . Videography in Pediatric Emergency Research : Establishing a Multicenter Collaborative and Resuscitation Registry . Pediatr Emerg Care . 2020 May ; 36 ( 5 ): 222-228 .
TARA NEUBRAND , MD
Director , ED Resuscitation , Children ’ s Hospital Colorado
Assistant professor , Pediatrics-Emergency Medicine / Urgent Care
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