(1523) NRP and PALS in ICU Code Events at a Quaternary Care Pediatric Hospital: A "Compressed" Analysis

Introduction: Neonates, infants, and toddlers in a code event (defined as chest compressions of any duration) are resuscitated using either neonatal resuscitation program (NRP) or pediatric advanced life support (PALS). The method used for resuscitation varies among institutions and intensive care units (ICU) as the optimal age to transition from neonatal to pediatric resuscitation guidelines is unknown. At Children’s Mercy—a quaternary care pediatric hospital—NRP is used in the level IV neonatal intensive care unit (NICU) and PALS is used in the pediatric (PICU) and cardiac intensive care units (CICU). This study's objective was to describe the clinical characteristics of code events in the NICU, PICU, and CICU for patients in the same age group undergoing resuscitation with different protocols (NRP, PALS).

Methods: Single-center retrospective observational study comparing code events between the NICU, PICU, and CICU. Inclusion criteria were age (36 weeks post-menstrual age to 18 months chronological age), admission to NICU/PICU/CICU, and code event requiring chest compressions between January 2020 to July 2023. Demographics, medical history, pre-event/event characteristics, and survival outcomes were collected and descriptively summarized.

Results: This study included 170 code events (79 NICU, 25 PICU, 66 CICU). PICU patients were older and bigger at the time of arrest than NICU and CICU patients (p < 0.001). Average times to initiate chest compressions and duration of compressions were similar across units. A primary respiratory etiology for arrest was identified in 80% of NICU and 64% of PICU code events, whereas a cardiac etiology was identified in 76% of CICU code events (p < 0.01). Medications administered during arrest varied between units. There was no difference in event survival between the ICUs.

Conclusions: We found that outcomes of code events were similar in the NICU, PICU, and CICU despite significant differences in patient characteristics, etiology of arrest, and management of cardiac arrest events. Based on our findings, we speculate that using patient age as a marker for transitioning from neonatal to pediatric resuscitation guidelines is unlikely to improve outcomes. Further analysis will include comparison of outcomes in patients with congenital heart disease who receive NRP versus PALS.