560 - Feasibility and Development of a Multicenter NICU Cardiac Arrest Database: A Survey of Neonatal Resuscitation Leaders

Publication Number: 3541.560

Summer Elshenawy, Children's Healthcare of Atlanta, Atlanta, GA, United States; Erwin T. Cabacungan, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, United States; Patrick J. Peebles, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Ruby Gupta, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Cecilie Halling, Nationwide Children's Hospital, Columbus, OH, United States; Elizabeth Schierholz, Children's Hospital Colorade, Denver, CO, United States; Anne Ades, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Megan M. Gray, University of Washington School of Medicine, Seattle, WA, United States; Noorjahan Ali, University of Texas Southwestern Medical School, Dallas, TX, United States; Mary Haggerty, Children's Hospital of Philadelphia, haddonfield, NJ, United States

Background: Neonates who experience in-hospital cardiac arrest (IHCA) represent a distinct population not captured in delivery-room resuscitation studies or pediatric IHCA registries. CPR occurs in 1% of patients in quaternary NICUs, tenfold higher than in the delivery room. Despite this, only 9% of centers contribute to national registries such as the AHA Get With the Guidelines (GWTG), participation in which is associated with improved IHCA survival. Unique neonatal resuscitation challenges and limited NICU-specific data hinder understanding of risk factors, performance, and outcomes. A multicenter NICU-specific database informed by expert consensus is needed to enable benchmarking, quality improvement, and research.

Objective: To determine feasibility and consensus around data elements for a multicenter NICU IHCA database.

Design/Methods: An electronic REDCap® survey was distributed to resuscitation representatives from 42 NICUs within the Children's Hospitals Neonatal Consortium (CHNC). Participants rated agreement with the AHA cardiac arrest definition and 51 candidate data elements using a 5-point Likert scale, and feasibility (yes/no). Elements were grouped by IHCA phases: pre-event, cardiac arrest process, post-event and outcome. Core elements were defined as median agreement ≥4 and ≥90% feasibility; supplemental elements as median agreement ≥4 and ≥70% feasibility. The study was IRB-exempt.

Results: Twenty-three of 42 sites responded (54%), with 20 complete surveys (48%). Respondents were neonatologists involved in NICU resuscitation practices and policy development at quaternary centers. Nearly all had substantial clinical experience; 18/20 had >6 years of practice and most (13/20) had >10 years, while only two respondents had ≤5 years of experience. Eighty-six percent agreed with the AHA definition of cardiac arrest. Only three sites currently report neonatal resuscitation data to a national registry. Thirty-four data elements met criteria as core and 10 as supplemental; 10 did not meet criteria (Tables 1-3).

Conclusion(s): Neonatal resuscitation experts across CHNC centers agreed that development of a NICU IHCA database is feasible and essential. This consensus process identified high-value, feasible NICU-specific data elements and established a foundation for a multicenter registry for quaternary NICUs. Implementation of the first dedicated NICU IHCA registry is now underway, enabling benchmarking, risk-prediction efforts, and future interventional studies to improve outcomes following neonatal IHCA.

Table 1. Pre-event Data Elements
Pre-event variables rated by CHNC sites for inclusion and feasibility in a NICU IHCA registry. Median reflects agreement on candidacy to collect each element. Core elements: median ≥4 & ≥90% feasibility; supplemental: median ≥4 & ≥70% feasibility.

Table 2. Cardiac Arrest Process Data Elements
Cardiac arrest-phase variables rated for registry inclusion and feasibility. Median reflects agreement on candidacy to collect each element. Core elements: median ≥4 & ≥90% feasibility; supplemental: median ≥4 & ≥70% feasibility.

Table 3. Post-resuscitation and Outcome Data Elements
Post-resuscitation and outcome variables rated for registry inclusion. Median reflects agreement on candidacy to collect each element. Core elements: median ≥4 & ≥90% feasibility; supplemental: median ≥4 & ≥70% feasibility.