Determinants of Pediatric Cardiac Arrest and Post-Arrest Care in Community Emergency Departments

Introduction: Pediatric cardiac arrest (CA) is a low-frequency event with high morbidity and mortality. Many pediatric CA patients present to community EDs (CEDs) for arrest or post-arrest care. Few studies have examined how to strengthen pediatric resuscitation systems in CEDs. We performed a contextual inquiry among CED clinicians to elicit determinants of optimal pediatric CA management.


Methods: Guided by the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, we conducted semi-structured interviews with multidisciplinary clinicians at five regional community hospitals. Transcripts were coded using thematic analysis. Interview content was analyzed throughout data collection to ensure sufficient sample size to achieve thematic saturation.


Results: We achieved thematic saturation after 25 interviews. The following themes, which were primarily aligned with the ‘inner context’ level of the EPIS, emerged: variable resource availability (subthemes: day of week and time of day; assigned roles), high cognitive workload, workforce education and retention (subthemes: nursing shortages; staff experience), and protocolization (subthemes: cognitive aids; algorithms; institutional protocols). Facilitators of effective pediatric CA care included pre-arrest briefing, a calm leader, and clear communication. Barriers included overcrowding, technical difficulties, and psychological stress. Clinicians frequently reported lack of familiarity with pediatric equipment and weight-based dosing. No sites employed pediatric post-arrest protocols. Preliminary implementation mapping highlighted high-yield interventions opportunities to improve team performance, including: 1) multidisciplinary simulation incorporating post-arrest care; 2) unit-specific cognitive aid development and dissemination; and 3) hands-on practice preparing weight-based medications and locating appropriately-sized pediatric equipment.


Conclusions: Multiple facilitators and barriers influence pediatric CA and post-arrest management in CEDs. This inquiry revealed several modifiable inner context factors that may guide future efforts to improve pediatric resuscitation in community settings.