Targeted Temperature Management After Pediatric Cardiac Arrest: A Quality Improvement Program With Multidisciplinary Implementation in the PICU

We aimed to implement a post-cardiac arrest targeted temperature management (TTM) bundle to reduce the percent of time with a fever from 7% to 3.5%. A prospective, quality improvement (QI) initiative utilizing the Method for Improvement. The pre-intervention historical control period was February 2019 to March 2021, and the intervention test period was April 2021 to June 2022. The PICU of a freestanding, tertiary children's hospital, in the United States. Pediatric patients 2 days old or older to 18 young or younger than years old who experienced cardiac arrest, received greater than or equal to 2 minutes of chest compressions, required invasive mechanical ventilation post-resuscitation, and had no documented limitations of care. We developed and implemented a TTM bundle that included standard temperature goals, instructions and training on cooling blanket use, scheduled prescription of antipyretics, an algorithm for managing shivering, and standardized orders in our electronic health record. We reviewed data from 29 patients in the pre-intervention period and studied 46 in the intervention period. In comparison with historical controls, the reduction in median (interquartile range [IQR]) percentage of febrile (> 38°C) time per patient associated with the TTM bundle was 0% (IQR, 0-3%) vs. 7% (IQR, 0-13%; p < 0.001). The intervention period, vs. pre-intervention, was associated with fewer patients with fever at any time (16/46 vs. 21/29; mean reduction, 37%; 95% CI, 13.8-54.8%; p = 0.002). We failed to identify an association between the intervention period, vs. pre-intervention, and the development of hypothermia (< 35°C; 8/46 vs. 3/29; mean change, 7%; 95% CI, -10.9% to 21.8%; p = 0.40). In this QI project, we have demonstrated that implementation of a TTM bundle is associated with reduced duration and frequency of fever in patients who survive cardiac arrest.