2024-25 Annual Report

We had a fantastic year, made significant by all those involved, and we eagerly anticipate continuing this work and more in 2026!

Executive Summary

We are pleased to report that we met and exceeded our expectations and metrics for success while pursuing our goal of refinement and expansion of the international multi-center pediatric RESuscitation Quality (pediRES-Q) Collaborative “learning laboratory” with CHOP as the principal centralized Program, Clinical, and Data Coordinating Center. Specifically, we have expanded the assembly, linkage and expansion of a robust clinical quality improvement and research collaborative to over 65 leading children’s hospitals across the globe. Furthermore, we have leveraged the ZOLL Medical pediRES-Q grant and matching Nicoletti, AHA, RQIP, NIH, and CHOP funding to catalyze support that will eventually sustain pediRES-Q Collaborative’s vision to improve survival from cardiac arrest in children.

In the past year, we have onboarded 5 new sites, recruited and prepared 10 additional international sites (including Sub-Saharan Africa and India) to join the collaborative, expanded our international HUB locations in the Netherlands, Spain, and Italy, entered over 600 events into our database and published  9 peer-reviewed manuscripts. We conducted more than 15 international site visits and 12 local/regional outreach site visits. Our monthly collaborative site webinars/meetings average > 50 site investigators/attendees each month, joining from across the globe. Topics discussed ranged from clinical research to implementation science to quality improvement and topical panel discussions.

Externally funded research projects were approved and initiated this past year (e.g., NIH RO1 funded PEDICA (20 pediRES-Q sites): PI Ryan Morgan, NIH RO1 funded OPTI-VENT (20 pediRES-Q sites): PI Robert Sutton, AHRQ R21 funded SAMURAI (5 pediRES-Q sites): PI Maya Dewan) establishing the creation of our newly updated REDCap database system and strengthening  robust data collection, inclusive of defibrillator, monitor, ETCO2 and Arterial Blood Pressure waveforms submission from 20 PediRES-Q sites, as well as improved training and debriefing data capture.

Fiscal Year 2025 Deliverables

1. Identify and attain IRB approval and sign DUAs for inclusion of at least 4 additional institutions

   • Attained 5 new IRBs and DUAs for year 2024:

     • Children’s Minnesota (Minneapolis, Minnesota)

     • The Hospital for Sick Children (Toronto, Ontario)

     • Nemours Children’s Hospital of Delaware (Wilmington, Delaware)

     • The Children’s Hospital at Westmead (Westmead NSW, Australia)

     • Perth Children’s Hospital (Nedlands, Australia)

2. Collect, clean, and store at least 100 new events:

   1. Quantitative chest compression data (e.g., Depth, Rate, Chest compression fraction, Hemodynamic data), and Post-arrest data

      1. In the past year, over 600 cardiac arrest events were added to the database of which 137 had usable ZOLL data.

   2. Anthropometric data on at least 50 patients

3. Continue to lead development and expansion of data analytics, dashboards, and comparative benchmark data (See Appendix B).

   1. Dashboard updated to site-oriented design with default setting for site-specific data when the user logs-in. Increased data security.

   2. Combined two dashboards: main dashboard and data surveillance dashboard for easy access control.

   3. Easy benchmarking: Run chart has changed into box plot and line chart for site and the comparator group average. Comparator group have options by region (e.g., North America, Europe).

   4. Direct download: Download button of QI data and site report from the first page.

   5. Multilanguage functionality added.

4. Provide IT consultation to assist sites with integration of tools into electronic clinical systems and export of clinical data (i.e., automated identification of high-risk patients, export of physiologic data).

   • Provided consultation for Etiometry and HP Bedmaster and Sickbay and verified capability of data transmission at the following sites:

     • UT Southwestern

     • Cohen

     • Nemours

     • Columbia

     • Cincinnati

     • CHOA

     • Riley

     • Seattle

     • Boston

5. Provide at least 4 partner sites with resuscitation system assessment and assistance with individualized consultation, onsite or with CHOP visits/observations.

Site Visits:

Abu Dhabi (Gulf Region) Feb 2024

Kolkata, India March 2024

Kumasi, Ghana March 2024

Taiwan, China (Asian Pacific Region) March 2024, October 2024

University of Chicago May 2024

Chengdu and Guanzhou, China May 2024

Mexico City, Mexico June 2024

Stavanger, Norway June 2024, September 2024

Rome, Italy June 2024, September 2024

Kuching, Malaysia (Asian Pacific Region) June 2024

Bozeman, Montana July 2024

Lima, Peru August 2024

Bogota, Colombia September 2024

Geneva, Switzerland (Utstein and WHO ACAN network) October 2024

Athens, Greece (European Region: ESPNIC) November 2024

Buenos Aires, Argentina (Latin American Region: SLACIP) November 2024

Santiago de Composteles, Spain November 2024

Chennai, India December 2024

6. Conduct periodic investigator meetings (e.g., web-based discussions, scheduled monthly) and an annual meeting of site PIs.

   • Presenters from across the globe shared resuscitation research, projects, and quality improvement work. Topics included ECPR pauses during chest compressions, community outreach efforts, ILCOR, research in neurologic outcomes, epinephrine dosing during resuscitation and intra-arrest fluid administration plus quality improvement initiatives on live capturing of events, SAMURAI situational awareness, CHOP 10-Step example and challenges to achieving optimal resuscitation systems (See Appendix A).

7. Publish abstracts and submit manuscripts to high impact resuscitation journals.

   1. Publish ≥4 abstracts and submit ≥2 manuscripts to high impact resuscitation journals.

      
      

Publications

1. Lauridsen, K. G., Morgan, R. W., Berg, R. A., Niles, D. E., Kleinman, M. E., Zhang, X., Griffis, H., Del Castillo, J., Skellett, S., Lasa, J. J., Raymond, T. T., Sutton, R. M., Nadkarni, V. M., for the pediRES-Q Investigators (2024). Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation, 149(19), 1493–1500. https://doi.org/10.1161/CIRCULATIONAHA.123.066882

2. Ushpol, A., Je, S., Niles, D., Majmudar, T., Kirschen, M., Del Castillo, J., Buysse, C., Topjian, A., Nadkarni, V., Gangadharan, S., & PediRES-Q investigators (2024). Association of blood pressure with neurologic outcome at hospital discharge after pediatric cardiac arrest resuscitation. Resuscitation, 194, 110066. https://doi.org/10.1016/j.resuscitation.2023.110066

3. Raymond, T. T., Esangbedo, I. D., Rajapreyar, P., Je, S., Zhang, X., Griffis, H. M., Wakeham, M. K., Petersen, T. L., Kirschen, M. P., Topjian, A. A., Lasa, J. J., Francoeur, C. I., Nadkarni, V. M., for the pediatric Resuscitation Quality (pediRES-Q) Collaborative Investigators (2024). Cerebral Oximetry During Pediatric In-Hospital Cardiac Arrest: A Multicenter Study of Survival and Neurologic Outcome. Critical care medicine, 52(5), 775–785. https://doi.org/10.1097/CCM.0000000000006186

4. Albrecht, M., de Jonge, R. C. J., Dulfer, K., Van Gils-Frijters, A. P. J. M., de Hoog, M., Hunfeld, M., Kammeraad, J. A. E., Moors, X. R. J., Nadkarni, V. M., & Buysse, C. M. P. (2024). Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational study. Resuscitation, 194, 110045. https://doi.org/10.1016/j.resuscitation.2023.110045

5. Ushpol, A., Je, S., Christoff, A., Nuthall, G., Scholefield, B., Morgan, R. W., Nadkarni, V., Gangadharan, S., for the pediRES-Q investigators (2024). Evaluating post-cardiac arrest blood pressure thresholds associated with neurologic outcome in children: Insights from the pediRES-Q database. Resuscitation, 110468. Advance online publication. https://doi.org/10.1016/j.resuscitation.2024.110468

6. Albrecht, M., de Jonge, R. C. J., Del Castillo, J., Christoff, A., De Hoog, M., Je, S., Nadkarni, V. M., Niles, D. E., Tegg, O., Wellnitz, K., Buysse, C. M. P., for the pediRES-Q Collaborative Investigators (2024). Association of cumulative oxygen and carbon dioxide levels with neurologic outcome after pediatric cardiac arrest resuscitation: A multicenter cohort study. Resuscitation plus, 20, 100804. https://doi.org/10.1016/j.resplu.2024.100804

7. Yu, P., Lasa, J. J., Zhang, X., Griffis, H., Sweberg, T., Esangbedo, I., Ranganathan, A., Nadkarni, V., Raymond, T., for the pedi-RESQ Investigators (2024). Are chest compression quality metrics different in children with and without congenital heart disease? A report from the pediatric resuscitation quality collaborative. Resuscitation plus, 20, 100802. https://doi.org/10.1016/j.resplu.2024.100802

8. Ikeyama, T., Hozumi, T., Kikuyama, K., Niles, D., Nadkarni, V., & Ito, K. (2024). Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 25(8), 720–727. https://doi.org/10.1097/PCC.0000000000003515

9. Barreto, J. A., Wenger, J., Dewan, M., Topjian, A., & Roberts, J. (2024). Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action. Pediatric quality & safety, 9(3), e727. https://doi.org/10.1097/pq9.0000000000000727

   
   

Pending Manuscripts

1. February 2025: Interposed abdominal compressions provide diastolic benefit during cardiopulmonary resuscitation in the pediatric cardiac intensive care unit (PIs: Dan Howsman/Daniel Stromberg)

2. April 2025: Association of AHA guideline-compliant CPR mechanical targets with Survival (ROSC, Survival to Hospital discharge and  Favorable Neuro Outcome) (PI: Nadkarni)

3. May 2025: Characterization of a new CPR Performance Metric in Children: Chest Compression Release Velocity (PIs: Jennifer Hayes/Tommy Rappold)

4. June 2025: Delivery of CPR in Patients with Single and Biventricular Cardiac Disease (PI: Todd Sweberg)

5. November 2025: Hot debriefing frequency and CPR quality and outcomes (PI: Priti Jani)

November 2025: 1. Correlations of end-tidal carbon dioxide values with a) chest compression quality metrics and b) ventilation in pediatric cardiac arrest undergoing chest compressions and 2. Correlations of end-tidal carbon dioxide values with pediatric cardiac arrest SURVIVAL (PI: Priscilla Yu)

b. Develop protocols and submit grants related to the pediRES-Q study (e.g., R21, R03, R01, R24 NIH, industry, Foundation, or equivalent funding sources).

Grant Funding

National Institute of Health (NIH)

• NIH 1R01HL175433-01 PEDICA: Physiology-directed Epinephrine Dosing in Cardiac Arrest; 2024-2029

PI: Ryan Morgan, MD (Children’s Hospital of Philadelphia)

Aim: The goal is to better delineate the physiologic effects of epinephrine during cardiopulmonary resuscitation and how that information can inform more targeted epinephrine dosing strategies to improve outcomes.

• NIH 1R01HD114622-01A1 OPTI-VENT: OPTImal VENTilation to Improve Pediatric Cardiac Arrest Outcomes; 2025-2030

PI: Robert Sutton, MD (Children’s Hospital of Philadelphia)

Aim: The goal is to determine the effectiveness of a pediatric CPR ventilation training bundle to improve outcomes after pediatric in-hospital cardiac arrest in a prospective multicenter “adaptive,” parallel, hybrid stepped-wedge, cluster randomized interventional trial.

• Agency for Healthcare Research and Quality (AHRQ R18HS029630)

SAMURAI: Situation Awareness Incorporating MUltidisciplinary Teams Reduce Arrest In the PICU; September 2023 to August 2028

PI: Maya Dewan, MD MPH (Cincinnati Children’s Hospital Medical Center)

Aim: Primary focus is on unit-based interventions to reduce the incidence of IHCA in PICUs using quality improvement methodology. To improve success of future intervention, this study collects additional information on attitudes, behaviors, and intervention usability, fidelity, and acceptability of the intervention by a collective group of stakeholders.

• Nicoletti Academy for Resuscitation of Children; 2021-2026

PI: Vinay Nadkarni, MD (Children’s Hospital of Philadelphia)

Aim: Accelerate CHOP’s world-class emergency cardiovascular care systems into an innovation incubator, clinical learning laboratory and training academy rooted in the latest resuscitation science, in partnership with the American Heart Association.

• Laerdal Foundation/RQIP; 2021-2025

PI: Vinay Nadkarni, MD (Children’s Hospital Philadelphia)

Aim: For years 2023-2024, our goals included 1) disseminate 10-step program to pediRES-Q, 2) expand our international sites to include LMIC, 3) network to inject pediatric modules into EMS out-of-hospital training and 4) collect, analyze and publish data that informs ILCOR and constituent international resuscitation councils.

• CHOP Frontier Program Grant; CHOP Delivery Room of the Future; 2023-2026

PI: Elizabeth Foglia, MD; Anne Ades, MD; Natalie Rintoul, MD (Children’s Hospital of Philadelphia)

Aim: To provide every infant a chance at the healthiest outcomes and quality of life. Human Factors Science prospective application to optimize provider performance during resuscitation. Develop innovative and integrated digital tools to support providers in real-time during neonatal resuscitation.

• CHOP Chair’s Initiative

CHOP Outreach Center for Expertise in Pediatric Emergency Readiness and Training (ExPERT); July 2023-June 2025, $100,000/yr (partially funded July 2025-June 2026 by Measey Foundation)

PIs: Yen Tay, MD, Theresa Walls, MD, Megan Lavoie, MD, Mary Haggerty, MD, Grace Good, John Erbayri, Brooke Bauman (Children’s Hospital of Philadelphia)

Aims: 1) Expand CHOP’s outreach efforts within and beyond our network and affiliates to all providers that care for children and who seek to gain knowledge and training for pediatric emergency care, 2) Establish a CHOP OPEN site with an intake process to allow participating agencies/hospitals to request outreach and identify educational needs as well as access additional training materials, 3) Build a robust program of outreach education and training offerings tailored to individual requests, and 4) Document and disseminate the outcomes of the collaborative efforts. Thus far, we have done multiple events in the prehospital/ambulatory/ED/inpatient setting. We presented our work to the Division of Pediatrics as well as at IPE day.

ExPERT: High Quality CPR Training Pilot for Out-of-Hospital Cardiac Arrests (OHCA)

Led by: John Erbayri, MS (Children’s Hospital of Philadelphia)

Aim: The High-Quality CPR Training Pilot with Radnor Police Department (PD) is an innovative initiative aimed at improving survival rates for out-of-hospital cardiac arrests (OHCA) through enhanced first responder intervention. This program will equip Radnor PD officers with the skills and knowledge to perform high-quality chest compressions, focusing on depth, rate, and full recoil, which are critical components of effective CPR.

Through hands-on training with QCPR manikins, officers received real-time performance feedback to ensure measurable improvements in compression quality. The training emphasized the "Treat on the X" approach, reinforcing the importance of delivering care at the scene without delay, rather than moving the patient prematurely.

The pilot demonstrated improved CPR performance among officers. By empowering law enforcement as first responders, this initiative aimed to strengthen the chain of survival and enhance community outcomes for cardiac arrest victims.

• Improving Pediatric Acute Care Through Simulation (ImPACTS); Toyota Foundation

PIs: Theresa Walls, MD, Yen Tay, MD, Megan Lavoie, MD.

Aims: 1) To assess, measure, and compare the performance of EMS teams from different systems of care and different geographic regions in standardized simulated pediatric resuscitation scenarios and 2) to explore the association of EMS teams’ performance in a simulated setting with pediatric readiness as measured by the Prehospital Pediatric Readiness Project (PPRP) assessment. Sites are engaging with EMS agencies and completing sims by the end of February 2025.

8. Develop protocols and submit grants related to pediRES-Q study

Grants Submitted/Pending

1. National Science Foundation (NSF)

SPARC: Smart, Personalized, Adaptive, Responsive Cardiopulmonary Resuscitation (CPR) Systems; Start Date: September 2026-2031, $25,000,000 [Not funded]

PI: C. Nat Nataraj, PhD (Villanova Center for Analytics of Dynamic Systems)

Aim: Dr. Nataraj is collaborating with researchers from Children’s Hospital of Philadelphia using data analysis to improve the success rate of CPR in hospitals. The goal is to enable automated, intelligent CPR systems that will be personalized for the patient, diagnose cause of arrest and assess biomarkers.

2. CHOP Cardiac Center

HEARTS: Helping Empower and Assist in Recovery from Trauma following Sudden Cardiac Arrest; 2025-2026, $100,000 [Partially funded for $20,000 by CHOP]

PI: Victoria Vetter, MD, MPH (Children’s Hospital of Philadelphia)

Aim: To provide emotional support beyond the standard clinical care for OHCA patients. HEARTS will also be able to provide resources to others impacted including families, friends, bystanders, first responders, schools, communities, and medical staff regardless of race, ethnicity and socioeconomic status.

3. CHOP Global Health (Holman Africa Fund)

Efficacy of a novel, contextualized pediatric resuscitation educational intervention in Botswana and Ghana; 2025-2027, $150,000 [Partially funded for $75,000]

PI: Madiha Raees, MD (Children’s Hospital of Philadelphia)

Project Synopsis: To study the efficacy of a novel, contextualized resuscitation educational intervention in referral hospitals in Ghana and Botswana. Concurrently, we plan to analyze epidemiological data to identify contributors to morbidity and mortality in pediatric patients.

9. Support the development of additional international hubs:

a. Assistance with the translation of the pediRES-Q protocol and regulatory materials into local language, as needed.

• Spanish, Dutch, Japanese, Italian

b. Assistance with the translation of pediRES-Q data collection materials into local language, as needed.

• Multilanguage functionality added to change the displayed language on the dashboard (Arabic, Chinese, Danish, Dutch, French, German, Italian, Japanese, Korean, Portuguese, Russian, Spanish). Example below in Italian language.

c. Assistance with the translation of the pediRES-Q REDCap database for use by the hub regional center

• Spanish, Dutch, Japanese, Italian

d. Completion of site visits to the Regional Hub(s) to train and launch as independent data collection centers to support and collect data for their geographic region and/or language.

• Spain, Italy, India, Taiwan, Argentina

• Rotterdam planned for 2025

Platform Development

pediRES-Q has continued to grow and welcomed new partners to the platform. We continue to publish new standards for post-arrest care, provide a pipeline for supporting resource limited sites and collaborate across the network to share new and upcoming advancements in pediatric cardiac arrest care.

pediRES-Q remains steadfast paving the way for new sites to create local registries for post-arrest care and quality improvement. We continue to expand our partnership with sites outside the United States while navigating varying regulatory requirements.

New partners that have joined us in 2024

1. Children’s Minnesota (Minneapolis, Minnesota)

2. The Hospital for Sick Children (Toronto, Ontario)

3. Nemours Children’s Hospital of Delaware (Wilmington, Delaware)

4. The Children’s Hospital at Westmead (Westmead NSW, Australia)

5. Perth Children’s Hospital (Nedlands, Australia)

Exploring relationships with the following hospitals

The Bangalore Hospital (Bengaluru, India)

Chandigarh Hospital (Punjab, India)

Vellore CMC Hospital (Vellore, India)

AIIMS Kalyani Hospital (Rishikesh, India)

Kumasi Hospital (Ghana, Africa)

Hospital Italiano de Buenos Aires (Buenos Aires, Argentina)

Hospital General de Niños R. Gutiérrez (Buenos Aires, Argentina)

Hospital Acosta Ñu Asunción (San Lorenzo, Paraguay)

Hospital Roberto del Río (Región Metropolitana, Chile)

María Hospital, Pediatric Specialties (Tegucigalpa, Honduras)

International HUB Locations

Netherlands – Corinne Buysse

Spain – Jimena del Castillo

Italy – Orsola Gawronski

India – Arun Bansal

Latin America – Daniel Orqueda

Gulf Region – Ikram Haque

Oceania – Andrea Christoff

Hardship Funding

Thank you to our sponsors for the continued support for sites to access supplemental funding and continue participating in pediRES-Q.

Our applicants/awardees for 2024

Bambino Gesù Children's Hospital IRCCS (Rome, Italy): $4,000

Perth Children’s Hospital (Nedlands, Australia): $4,000

Outreach

CHOP’s Center for Life Support Education & Outreach trained Montgomery County first responders on pediatric emergency response. Led by John Erbayri CHOP Center for Life Support and Education Manager, the CHOP team trained 17 emergency response agencies of Montgomery County.

The day-long training session ensured the agencies were equipped with the education, resources, and tools to adequately respond to emergencies for pediatric patients. CHOP also gave each agency manikins to use in their own spaces as part of a Train the Trainer approach, that will allow the agencies to continuously train and educate their staff. This training is supported by CHOP’s Office of Community Impact. 

In addition to local emergency response outreach training, the team had the opportunity to travel to Botswana and expand the reach of CHOP to help children in that region. The weeklong training included a mix of didactic and simulation teaching the basic skills needed for pediatric CPR, workshops mimicking Pediatric Advanced Life Support (PALS) program training, discussions on how healthcare workers can support the prehospital care for children to ensure they receive the specialized attention needed before reaching a hospital, poster presentations allowing for networking amongst the group of more than 30 paramedics, physicians, and nurses and ended with meeting the American Heart Association (AHA) representative of South Africa and Sub Sahara Africa.

Team Updates

Program Manager Dana Niles transitioned her role to Abhay Ranganathan in June 2022. Abhay was Program Manager from 2022-2024 before moving to Canada. Our Clinical Nurse Specialist Kelly Papili remains as the pediRES-Q lead for clinical and quality initiatives partnering with Katie Graham who leads our data and research aspects of pediRES-Q and is the program manager of the Resuscitation Science Center (RSC).

In October 2024, we sub-contracted the University of Utah Data Coordinating Center (DCC) for statistical support. Led by Ron Reeder, the team provides comprehensive statistical support for our pediRES-Q Collaborative, NIH and AHRQ funded clinical studies, manuscript oversight committee (MOC) process, statistical analysis, and project management.

2024-25 Annual Report.

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