Improved Code Team Performance and Outcomes After Implementation of Moderate Fidelity In Situ Simulation in a Pediatric Cardiac Acute Care Unit

Children with cardiac disease suffer higher rates of in-hospital cardiac arrest. Cardiac arrest outside of the intensive care unit (ICU) is an infrequent event, which is a threat for suboptimal code team performance. Shorter time to the first epinephrine dose during cardiac arrest has been associated with improved survival and neurologic outcomes. Moderate fidelity in situ simulation training was implemented in the pediatric cardiac acute care unit (PCACU) to improve code team performance in August 2015. A small interprofessional team of simulation facilitators was developed that included nurses, physicians, and advanced practice providers. The primary outcome was time to first epinephrine dose in pulseless electrical activity (PEA) scenarios. Time to epinephrine of all simulation exercises, and actual cardiac arrests, that occurred in the PCACU were reviewed through May 2022. A total of 72 simulations were performed and 42 (58%) were PEA scenarios. A center line shift was observed for time to epinephrine for simulated PEA cardiac arrests (from 5 to 3 min). After implementation of simulation exercises, a center line shift was observed for time to epinephrine for actual cardiac arrests in the PCACU (from 8 to 2 min). Survival to hospital discharge after cardiac arrest improved after implementation of the training (0% vs. 64%, p = 0.02). Code team performance, as measured by time to epinephrine, can be improved following implementation of in situ simulation exercises in a pediatric cardiac acute care unit. Optimizing code team performance may contribute to improved patient outcomes.