Creating Digital Health Solutions for Pediatric Advanced Life SupportNovember 12, 2020
Cardiac arrest in children is rare, but when it does occur, the stakes are high.
16,000 cases of pediatric cardiac arrest occur each year with a survival rate of 10-15%
Imagine treating an infant or young child in the ICU or ER when breathing stops, the heart stops, and a code is called. Time can feel frozen and confusion can set in, yet every second is critical to saving that child’s life.
Augmented intelligence in the form of a clinical decision support and documentation technology – like the Redivus Health pediatric advanced life support (PALS) software – is bringing digital health solutions to the often overlooked pediatric space.
Infrequency Creates Anxiety
Doctors and nurses in large children’s hospitals use pediatric advanced life support (PALS) several times each month and have experienced code teams to execute a high level of care. But for providers in emergency departments in general hospitals, pediatric cases may be few and far between.
“With a good, experienced team, running a code is like a symphony or a ballet. It’s high intensity, but everyone is doing what they’re supposed to do and knows their role,” said Dr. Anya Freedman, Division of Critical Care for Cardinal Glennon Children’s Hospital in St. Louis. “You’re coordinated as a team.”
“But it doesn’t always go that way,” she continued. “When pediatric cardiac arrest happens where people aren’t used to handling it, it can be chaos. Lots of people are talking at once, and it feels like no one is in charge. It’s like a hive of bees.”
This lack of experience or familiarity with PALS can create heightened anxiety when a child presents in cardiac arrest. The pressure of trying to save a child’s life while remembering the infrequently used PALS algorithm can be overwhelming.
Intelligent Support Creates Confidence
Staying calm and in control is critical for the code team during any cardiac arrest.
“There’s a heightened sense of anxiety and a surge of internal adrenaline when a pediatric code happens,” Freedman said. “Because we run codes less frequently in children than they do in the adult world, there’s more need for support and more of a need to have tools in place to help manage them, like an app that guides you through the algorithm, in addition to doing simulations to practice.”
The Redivus Health PALS app augments the code team’s care by providing prompts for each step as they administer the algorithm. Additional support features include:
- Adjusting dosage of medications based on child’s weight (measured or estimated with Broselow Tape)
- Adjusting strength of defibrillation shocks based on weight
- Multiple timers with prompts for medications and chest compressions
These prompts and calculations, called out by the code recorder using the Redivus app, simplify and streamline the code team’s response, creating a sense of confidence that the team is doing the right thing at the right time.
Synchronized Updates to PALS Algorithm
In October 2020, the American Heart Association released updates to the PALS algorithm to reflect the latest standards in pediatric cardiac care.
“When the algorithm changes and you’ve been doing it one way for many years, and now you have to remember to do it differently, that’s a challenge,” Freedman said. “It increases the chance of error.”
With Redivus, those updates are validated by subject matter experts and programmed into the app’s code, so the next time the app is opened, the new algorithm is implemented. This increases the chances that the code team will adhere to the recommended guidelines and improves chances for the child’s survival.
Documentation at the Touch of a Button
During a pediatric code, one member of the code team must record times and measurements for vital signs, medications and dosages, compressions, etc. Different hospitals use different tools, ranging from paper forms to EMR systems, to whatever scraps of paper are available.
This documentation is important both for the accuracy of patient records and to allow the hospital to analyze data and make improvements.
“The ideal situation, given the technology currently available, would be to have electronic documentation using a tablet or phone,” Freedman said. “Simply pressing a button to indicate that a medication (including the dose) has been administered, or that compressions have started or stopped, makes it much easier than trying to write everything down on paper.”
The Redivus PALS app creates accurate, real-time documentation as the code recorder inputs information into the app from any device:
- Documents every intervention during the code using drop-down menus and user-friendly functionality, allowing the user to add comments or make edits after the event
- Records medication doses and how meds are given (IV, IO, ET tube)
- Time-stamps every intervention to the second
- Integrates with any EMR to upload code blue documentation to the patient’s chart
“The app has the capability to guide us through the algorithm while simultaneously providing for accurate documentation. Solving both problems at once is a thing of beauty.”
— Dr. Anya Freedman, Division of Critical Care, Cardinal Glennon Children’s Hospital
Aggregating Data to Analyze
When the code ends, regardless of the outcome, the data collected and documented provides an opportunity for the hospital to learn and improve the quality of care. The Redivus Health platform provides extensive analytics, such as type of presenting rhythm, compression fraction, time to first compression, time to first shock, and ROSC.
“The app has the ability to analyze data and simplify data collection so I can look at it more critically,” Freedman said. “Real-life data helps us improve. It allows us to more easily figure out where to focus our efforts in order to improve our performance overall. Additionally, the ability to use aggregate data from a large number of codes over a long period of time would be in the AI realm, potentially helping discern what changes to make to the guidelines based on patient outcomes.”