A practical study on a stepwise simulation intervention guided by video review to improve the quality of cardiopulmonary resuscitation in the pediatric emergency department.

BACKGROUND: Maintaining high-quality cardiopulmonary resuscitation (CPR) in pediatric emergency departments remains challenging. Evidence supporting integrated quality improvement strategies combining video review and in situ simulation is limited. OBJECTIVE: To evaluate whether implementation of a video review-guided stepwise quality improvement strategy was associated with improved CPR process quality across three sequential implementation phases. METHODS: This single-center before-after quality improvement study included consecutive pediatric cardiac arrest cases treated between January 2025 and February 2026. A video review-guided stepwise intervention was implemented in three phases: baseline (Group A), structural optimization (Group B), and behavioral reinforcement with monthly in situ simulation (Group C). The primary outcomes were chest compression fraction (CCF) and return of spontaneous circulation (ROSC). RESULTS: Fifteen pediatric cardiac arrest cases were included (n = 5 per group). Median CCF increased from 80.2% (74.8-85.0) in Group A to 84.0% (83.4-88.6) in Group B and 91.3% (91.0-91.5) in Group C. An overall comparison demonstrated a significant difference among the three phases (P = 0.035), with post hoc analysis showing a significant difference between Groups A and C (P = 0.016). The median number of prolonged chest compression interruptions per case decreased, and role allocation improved (P = 0.045). No significant difference in ROSC was observed (P = 0.999). Airway management and patient assessment were the leading causes of prolonged interruptions. CONCLUSIONS: Implementation of a video review-guided stepwise quality improvement strategy was associated with improved CPR process quality. This approach may provide a practical framework for continuous resuscitation quality improvement and warrants further evaluation in multicenter studies.