Multi-center observational study of the relationship of ventilation and outcomes from cardiac arrest using existing data

使用现有数据对通气与心脏骤停结果之间的关系进行多中心观察研究

• 批准号: 10330007
• 负责人: AHAMED H IDRIS
• 金额: $ 12.12万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10330007
• 关键词: Address; Adult; Affect; Attention; Blood; Blood Circulation; Brain; Cardiopulmonary Resuscitation; Chest; Clinical Data; Clinical Trials; Computational algorithm; Data; Data Files; Databases; Defibrillators; Devices; Electrical Resistance; Enrollment; Frequencies; Future; Goals; Guidelines; Heart; Heart Arrest; Hospitals; Incidence; Lead; Lung; Masks; Measurement; Measures; Methods; Monitor; Morbidity - disease rate; Multi-Institutional Clinical Trial; Multicenter Studies; Multicenter Trials; Neurological outcome; Observational Study; Organ; Outcome; Oxygen; Patient-Focused Outcomes; Patients; Performance; Perfusion; Persons; Public Health; Research; Resuscitation; Role; Science; Site; Survival Rate; Tidal Volume; Time; Tissues; Training; United States; arm; clinical research site; improved; improved outcome; mortality; neglect; new technology; novel; novel strategies; out-of-hospital cardiac arrest; primary outcome; resuscitative care; survival outcome; trial comparing; ventilation

Project Summary/Abstract Introduction: Out-of-hospital cardiac arrest (OHCA) is a major public health problem that affects over 350,000 adults in the United States each year. Survival from OHCA remains unacceptably low despite promising advances over the last decade. During cardiac arrest, all circulation stops. Quickly restoring circulation and oxygenation to vital organs such as the heart and brain are important goals of out of hospital cardiac arrest (OHCA) resuscitation. Cardiopulmonary resuscitation (CPR) combines chest compressions with lung inflation to restore perfusion and oxygenation to the body. During the past decade, research focused on measuring chest compressions during CPR has lead to improvements in performance of chest compressions and increased survival rates. However, ventilation has long been a “neglected parameter” in CPR research, in part, because measuring ventilation during OHCA and CPR is difficult. To address this problem, we developed a novel method for measuring ventilation during CPR using thoracic bioimpedance (electrical resistance), which can be monitored through defibrillator pads placed during CPR. Using data from the Resuscitation Outcomes Consortium Dallas-Fort Worth site, we showed that good quality ventilation is associated with improved outcomes such as survival to hospital discharge. However, a multi-center study is necessary to establish the generalizability of those findings. Objectives: To measure ventilation metrics and to determine the association of ventilation during standard CPR with outcomes such as survival to hospital discharge and survival with favorable neurological outcome in patients suffering OHCA. Methods: The study will use data from one of the largest, comprehensive OHCA multi-center trial in the world. The ROC Continuous Chest Compression (CCC) Trial database includes CPR resuscitation metrics, patient outcomes, and access to defibrillator bioimpedance recordings, a rare combination for a cardiac arrest database. A validated method to identify acceptable bioimpedance ventilation waveforms has been programmed into an automated computer algorithm, which will extract ventilation data from defibrillator recordings from approximately 4,000 patients from six ROC sites that participated in the CCC Trial. Ventilation data will be matched with clinical data for each case. Specific Aims: 1) To determine ventilation frequency, incidence, tidal volume, and inspiratory and expiratory times from the 30:2 CPR defibrillator files of six participating ROC regional clinical sites. 2) To determine if ventilation frequency, incidence, and fraction during ventilation with a bag-mask device is associated with survival outcomes in the 30:2 CPR group. 3) Compare outcomes of the 30:2 vs. CCC groups of the CCC Trial. Significance: The results may provide evidence for a paradigm shift and impact CPR training, guidelines, and the future delivery of resuscitation care to hundreds of thousands of people annually in the United States.

项目总结/摘要 简介：院外心脏骤停（OHCA）是一个主要的公共卫生问题，影响超过35万人。 美国成年人每年。OHCA的生存率仍然低得令人无法接受， 过去十年的进步。在心脏骤停期间，所有循环停止。快速恢复血液循环， 重要器官如心脏和大脑的氧合是院外心脏骤停的重要目标 （OHCA）复苏。心肺复苏术（CPR）将胸部按压与肺充气相结合 恢复身体的灌注和氧合。在过去的十年里，研究的重点是测量 CPR期间的胸部按压已经导致胸部按压性能的改善， 提高生存率。然而，通气长期以来一直是CPR研究中的“被忽视的参数”， 部分原因是在OHCA和CPR期间测量通气量是困难的。为了解决这个问题，我们开发了 一种使用胸生物阻抗（电阻）测量CPR期间通气的新方法， 其可以通过在CPR期间放置的除颤器垫来监测。使用复苏的数据 结果联盟达拉斯-沃斯堡网站，我们表明，良好的通风质量与 改善的结果，如从存活到出院。然而，多中心研究是必要的， 建立这些发现的普遍性。 目的：测量通气指标并确定标准通气期间的通气相关性 心肺复苏术的结局，如出院生存率和良好神经结局的生存率， 患有OHCA的病人 方法：该研究将使用来自世界上最大，最全面的OHCA多中心试验之一的数据。 ROC连续胸外按压（CCC）试验数据库包括CPR复苏指标、患者 结果，并获得除颤器生物阻抗记录，这是心脏骤停的罕见组合 数据库一种经验证的方法，以确定可接受的生物阻抗通气波形， 编程到自动计算机算法中，该算法将从除颤器中提取通气数据 来自六个ROC研究中心的大约4,000名患者的记录，这些患者参加了CCC试验。通风 数据将与每个病例的临床数据相匹配。 具体目的：1）确定通气频率、发生率、潮气量、吸气和呼气 来自六个参与的ROC区域临床站点的30：2 CPR除颤器文件的时间。2)以确定是否 在使用袋式面罩装置进行通气期间，通气频率、发生率和分数与以下因素相关： 30：2 CPR组的生存结局。3)比较CCC试验中30：2与CCC组的结果。 意义：研究结果可能为模式转变和影响CPR培训，指南和 在美国，未来每年向数十万人提供复苏护理。