reviewed in detail by an open, multidisciplinary committee provides an opportunity to improve The review process focuses on time to critical events (completion of primary/secondary survey, vascular access, fluid/med administration, etc.), adherence to expected protocols, teamwork measures (including closed loop communication, ambient noise, anticipation of medications and equipment, etc.), specific role performance, and identification of barriers and facilitators to care Specific resuscitation events are chosen for review by a combination of provider request and identification of the highest-risk scenarios, including the most complex and least common events Process and system issues, educational deficits, and other barriers to protocol-compliant care identified through the video review process are addressed on an ongoing basis Interventions to improve quality of care in the resuscitation room can include changes in the physical resources available, such as medications, fluids and equipment, or personnel available For example, movement of the EZ-IO introducer and needles to the bed during room preparation prior to patient arrival can decrease the time to vascular access Assigning a second senior physician to supervise CPR and other procedures in resuscitation events requiring CPR, can decrease the burden on the leader physician and increase protocol compliance with CPR Using a Learning Healthcare System model, the continuous collection of system and care process data in addition to important team- and patient-level outcomes allows for ongoing identifications of new areas to be addressed and effects of interventions Other interventions to improve care may include simulated resuscitative events to allow for practice of uncommon events and identification of system and process weaknesses Multidisciplinary simulations that occur in the actual resuscitation environment are most likely to maximize learning and identify latent barriers to care In addition, participation in video resuscitation review simulates cognitive decision making for the viewer Finally, intermittent group review of important findings from the quality improvement efforts, targeted group education modules, and personal feedback on given resuscitation events can support improvements in provider behavior to maximize protocol adherence and decrease variability in resuscitation care It is important that EDs identify a feasible means to monitor resuscitation care and provide ongoing local quality improvement to insure that optimal care is provided in this high-stakes, error-prone environment ETHICAL ISSUES IN PEDIATRIC CARDIOPULMONARY RESUSCITATION