(1115) Development of a PICU "First Five" Curriculum: A Resuscitation Quality Improvement Needs Assessment

Introduction: Guidelines recommend specific interventions (e.g. timely epinephrine and defibrillation delivery) during cardiac arrest. However, prior work has shown inconsistent performance of these interventions. Our primary aim was to identify performance gaps in the first five minutes of IHCA care in our PICU, enabling the design of an educational program to address these gaps. We hypothesized that our team would have high compliance with epinephrine administration but low compliance with timely application of CPR monitoring devices within the first five minutes of arrest.

Methods: We conducted a multifaceted needs assessment including: 1) retrospective review of all IHCA with ≥2 minutes of CPR in our large, quaternary, urban PICU between 2022-2024; and 2) a multidisciplinary human factors task analysis. Quantitative metrics of compliance with guidelines were reported as counts with percentages or median times with IQR. During task analysis focus groups, we mapped our PICU-specific IHCA response and identified facilitators and barriers to guideline-compliant care and effective team communication.

Results: Among 113 cardiac arrests, 55 (49%) utilized a CPR mechanics quality monitoring device and 64 (57%) used ETCO2 monitoring. In events with a CPR quality monitor report, 9/46 (20%) placed the monitoring pads >5 minutes into CPR. The median time to epinephrine delivery was 2 minutes [IQR 1, 3] and only 9/68 (13%) received the first dose >5 minutes into CPR. The median time to defibrillation for initial shockable rhythms was 3.5 minutes [1,6] and 3/8 (38%) defibrillated >5 minutes into CPR. The task analysis identified obstacles related to patient summaries, role allocation, and room ergonomics as barriers to optimal care, and highlighted awareness of the importance of timely epinephrine delivery as a strength.

Conclusions: In a large, quaternary PICU we identified good compliance with timely epinephrine delivery but poor compliance with patient monitoring and defibrillation during the first five minutes of IHCA. A task analysis identified efficient role assignment, improved team ergonomics, and consistent communication of patient summaries as targets for educational intervention. Pre-post data will be collected after implementation of a simulation program addressing these aspects of resuscitation.