Dr. Jay Rakkar, pediatric intensivist and clinical informatics specialist at Phoenix Children's
Photo: Phoenix Children's
Pediatric post-cardiac arrest care guidelines are well established. Real‑world practice, however, can vary, leading to missed opportunities for timely, evidence‑based care.
THE CHALLENGE
Phoenix Children's wanted to close this gap by aligning bedside practice with the established guidelines.
"The challenge was that key elements of post-cardiac arrest care were not consistently visible, standardized nor easy to track across a fast-moving ICU environment," said Dr. Jay Rakkar, pediatric intensivist and clinical informatics specialist at Phoenix Children's. "After a pediatric cardiac arrest, teams aim to align quickly around a small set of evidence-based priorities. For example, confirming an echocardiogram is ordered, closely managing temperature and meeting blood pressure targets.
"But without an automated way to pull those things together, recognizing gaps and closing them depended on manual chart review and ad hoc communication," he continued. "Even after an order set existed, use of a targeted temperature management device remained relatively limited until the dashboard-and-alert workflow made those opportunities more visible and prompted timely follow-up."
The goal of the technology staff needed was to make it easier for clinicians to deliver the same high standard of care every time.
PROPOSAL
When a child survives cardiac arrest, the next hours and days are critical. By standardizing how temperature, blood pressure and brain monitoring are managed, clinicians can deliver the right care more consistently.
"We wanted to provide consistency across key elements of post-cardiac arrest care, and we knew we could achieve that by developing a post-cardiac arrest care dashboard with daily email alerts that gives clinicians actionable, automated feedback, they can quickly administer at the bedside," Rakkar explained.
"The clinical dashboard was to create a standardized, near-real-time 'safety net' for post-cardiac arrest care," he continued.
One place, he added, that automatically identifies when a child is admitted to the PICU/CVICU after a cardiac arrest and then has a standardized clinical process to evaluate:
- Targeted temperature management and fever prevention.
- Neurologic monitoring (EEG).
- Advanced physiologic monitoring (cerebral and somatic oximetry).
- Cardiac assessment (ECHO).
- Hemodynamic optimization.
"The intent was to make it easier for the clinical care team to consistently align around the same evidence-based priorities, without relying on time-consuming manual chart checks or variability in how information is shared during busy shifts and handoffs," Rakkar explained.
"To alleviate the challenge, it was designed to work as a closed-loop daily workflow," he continued. "Each morning, the system generates an email alert when a post-cardiac arrest patient was admitted in the prior 24 hours and the alert/dashboard shows how care is tracking against those targets."
A review team looks for outliers and then sends follow-up communication to the bedside team that same morning so any needed adjustments – for example, initiating or optimizing temperature management or tightening blood pressure goal adherence – can happen promptly. The technology pairs automated visibility with timely, supportive feedback, helping the unit move from retrospective review to consistent day-to-day reliability.
MEETING THE CHALLENGE
The internally built clinical dashboard was used as a way to develop an easy "identify, review and communicate" system to make post-cardiac arrest care more reliable and easier to execute consistently, Rakkar said.
"Each morning, the system generates an email alert when a child who had a cardiac arrest is admitted to the ICU – PICU or CVICU – in the prior 24 hours," he explained. "That alert effectively points the team to the relevant patient and summarizes how care is tracking against key post-cardiac arrest priorities. The goal wasn't to replace bedside judgment – it was to make it simple to spot outliers early and align the team around the same evidence-based steps.
"A small review group comprised of several members of the ICU clinical team reviews the alert/dashboard each day looking for anything that needs attention and then follows with the bedside team during the morning ICU huddle," he continued. "This allows the review team the opportunity to call out a recent cardiac arrest case and quickly reinforce the priorities for the day."
The post-cardiac arrest dashboard pulls data from more than a dozen places within the EHR and then pushes an email notification to the listed team members when criteria are met, like a post-cardiac arrest ICU admission in the last 24 hours. The EHR-backed dashboard plus an automated email distribution is followed by human-to-human communication to close the loop.
RESULTS
"While pediatric cardiac arrest remains one of the most challenging conditions in critical care, our work highlights how combining clinical expertise with real-time data systems and automated digital tools can improve care for some of the sickest children in the hospital," Rakkar said.
Some of the results, he reported, include the following:
- Between 2021 and 2025, the program was applied to 279 children treated after cardiac arrest and mortality rates improved by almost 10%. The dashboard translated complex recommendations into clear, real-time clinical targets, reducing variability in care and ensuring that key interventions were not missed during high-acuity periods.
- The use of temperature‑controlling devices to prevent fevers immediately after cardiac arrest increased dramatically, rising from about 40% of patients in 2021 to more than 90% in 2025. By making temperature goals visible and actionable, the dashboard reinforced early initiation of targeted temperature management.
- Dangerous fevers after cardiac arrest became much less common, dropping from 12% to 2%. This reduction is clinically meaningful, as post-arrest fevers are strongly associated with secondary brain injury. Improved temperature control contributes to better neurologic outcomes by minimizing additional brain injury during a highly vulnerable period.
- Consistent use of advanced monitoring improved, including higher use of EEG, cardiac imaging and brain oxygen monitoring. These modalities enabled earlier detection of secondary brain injury and cardiac dysfunction, allowing for more timely and targeted interventions.
"By centralizing key physiologic data and care goals in a single interface, our dashboard improved shared mental models across the care team," Rakkar concluded. "This facilitated clearer communication during rounds and handoffs, aligned decision-making across the care team and ultimately reduced fragmentation in care delivery."
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