The Airway, Breathing, Circulation—Plan, Risk, Options (ABC-PRO) Handover Tool in the PICU: Retrospective Evaluation of Pre- Versus Post-Implementation and Occurrence Rate of Cardiac Arrests, 2020–2023

Objectives: Healthcare improvement studies indicate a potential to reduce cardiac arrests in the PICU through anticipatory care and shared awareness. We developed a structured risk-assessment and anticipation tool (i.e., the Airway, Breathing, Circulation—Plan, Risk, Options [ABC-PRO]) for PICU patient handover and assessed the impact on cardiac arrest occurrence rate. Design: Single-center, retrospective healthcare improvement audit of before- vs. after-ABC-PRO tool implementation. Setting: Multidisciplinary, 25-bed PICU of the University Children’s Hospital, Zurich. Patients: Patients younger than 18 years admitted to the PICU (from January 2020 to September 2023) whose parents/guardians had not refused consent for general use of personal PICU administrative data. Interventions: We implemented the ABC-PRO handover tool and the primary outcome was the occurrence rate of cardiac arrests necessitating cardiopulmonary resuscitation, before vs. after the implementation. Cardiac arrest incidence was calculated per 1000 PICU-days using Poisson regressions, adjusted for age, sex, and Pediatric Index of Mortality. Measurements and Main Results: During 4,370 PICU admissions (21,804 PICU-days), there were 63 cardiac arrests in 59 patients. Of these, 43 occurred pre- (12,911 PICU-days), and eight post-implementation (6,156 PICU-days). The adjusted cardiac arrest occurrence rate pre- vs. post-implementation was 2.9 vs. 1.2 per 1000 PICU-days with an adjusted rate ratio (aRR, 0.42; 95% CI, 0.20–0.88) overall, 0.47 (95% CI, 0.20–1.1) among cardiac, and 0.48 (95% CI, 0.14–1.6) among noncardiac patients. Cardiac arrests decreased most in cardiac surgical patients (aRR, 0.23 [95% CI, 0.06–0.96]). However, we failed to identify a difference in cardiac arrest mortality pre- vs. post-implementation (17/41 vs. 1/8; mean percentage difference, 29%; 95% CI, 2–56%; p = 0.12). Conclusions: The ABC-PRO PICU handover tool provides a structured approach to risk-assessment and anticipation and may be associated with a decreased cardiac arrest occurrence rate in the PICU, with effects most pronounced in cardiac surgical patients.