Targeted Temperature Management to Improve In-Hospital Cardiac Arrest Outcomes in the Pediatric Intensive Care Unit

BACKGROUND: Targeted temperature management (TTM) is a critical element of post-cardiac arrest care pathways. Active prevention of hyperthermia and maintenance of normothermia is a TTM strategy associated with improved outcomes.

LOCAL PROBLEM: Our institution failed to initiate TTM within 12 hours after resuscitation. The project’s purpose was to implement TTM for in-hospital cardiac arrest (IHCA) patients in the Pediatric Intensive Care Unit. The project aims were for (1) ≥80% of IHCA patients to receive orders for TTM within one hour of ROSC and (2) ≥80% of IHCA patients to be placed on a homeothermic blanket within two hours of ROSC.

METHODS: The Evidence-Based Process Improvement model was utilized as the framework. A TTM protocol was implemented through Plan, Do, Study, Act cycles. Process measures included adherence to TTM order entry, homeothermic blanket use, and core temperature monitoring. Outcome measures included temperature recordings and PICU length of stay, survival, and morbidity.

INTERVENTIONS: Resources were created to support computerized order entry and homeothermic blanket machine use. They were linked to QR codes that were attached to each homeothermic blanket machine. A recorded PowerPoint presentation was shown to staff weekly.

RESULTS: There was a total of eight IHCA patients during the project timeline. Initial TTM order adherence and core temperature monitoring were 75%, with 0% homeothermic blanket adherence. Homeothermic blanket use increased to 75% during the project’s second month despite no TTM orders. Temperature control improved with homeothermic blanket use (Tmax 37°C, Tmin 35.6°C vs Tmax 38.1°C, Tmin 33.1°C). PICU survival and discharge morbidity improved with homeothermic blanket use (66.7% for both vs 40% for both).

CONCLUSIONS: The scarcity of IHCA events makes initial adoption and sustained adherence to practice change challenging. A concurrent electronic medical record change and a blanket supply shortage complicated implementation. Despite systemic challenges, which must be addressed for sustained success, our results demonstrate that TTM with a homeothermic blanket improves temperature control and survival for pediatric IHCA patients.