Improving Care After Cardiac Arrest by Informing Surrogate Decision Makers - Extension

项目摘要-通过通知代理决策者改善心脏骤停后的护理 心脏骤停后的存活率和神经恢复是高度可变的，部分原因是不一致 成功复苏后的医院护理。在以证据为基础的指南的交付方面存在重大差异 协调的护理与心脏骤停的总体结局的差异有关。When指南 神经功能恢复良好的患者存活率提高。然而，遵守关于以下方面的指南 推迟停止生命支持的决定在美国各医院都存在很大的差异。原因归因于 早期停止生命维持治疗包括对国家和国际指南了解不足， 家庭对早期结局预测的要求，以及家庭对危重护理的不完全理解。在……里面 为了鼓励使用符合延迟神经预测和伴随的指南 停止生命维持治疗(复苏72小时后)我们提出了一种新的方法；教育 并告知代理决策者神经预后的不确定性和指南一致性护理。这个 这项职业发展奖中提出的研究COVID扩展将试行一种新的干预措施， 将鼓励改善神经预测和延迟WLST的指南遵守情况，以及 支持莎拉·佩尔曼博士的持续发展，她是一位致力于改善 院外心脏骤停的结果。在这一扩展中，我们将继续对该工具进行试点试验，以 授权(TEMPO)心脏骤停昏迷幸存者的代理决策者 科罗拉多医院。该试验旨在确定该工具的可行性和可接受性，以及 关于心脏骤停后护理的知识转移。我们打算利用试点试验为 广泛推行节拍。试点试验的结果将进一步指导设计一种多用途的 中心务实临床试验实施教育工具，鼓励指南一致性 心脏骤停后护理，包括延迟神经预测和延迟撤除维持生命 心理治疗。总体而言，我们假设告知代理决策者关于指南一致性护理的信息，将 导致延迟决定停止生命维持治疗，并允许患者有足够的时间选择时间 进行适当的神经预测和唤醒，从而改善院外心脏疾病的预后 逮捕。这将是申请者未来独立研究提案的主题。

PROJECT SUMMARY – Improving care after cardiac arrest by informing surrogate decision makers Survival and neurological recovery after cardiac arrest are highly variable, driven in part by inconsistent hospital care following successful resuscitation. Significant variability in delivery of evidence based, guideline concordant care has been associated with differences in overall outcome from cardiac arrest. When guidelines are followed, survival with good neurologic recovery is improved. However, adherence to guidelines regarding delayed decision to withdraw life support has been highly variable across US hospitals. Reasons attributed to early withdrawal of life sustaining therapy include poor knowledge of national and international guidelines, requests from family for early outcome predications, and incomplete family comprehension of critical care. In order to encourage utilization of guideline concordant delayed neuro-prognostication and concomitant withdrawal of life-sustaining therapy (>72 hours after resuscitation) we propose a novel approach; to educate and inform surrogate decision makers on neuro-prognostic uncertainty and guideline concordant care. The research proposed in this career development award COVID extension will pilot test a novel intervention that will encourage improved guideline adherence on neuro-prognostication and delayed WLST as well as to support the continued development of Dr. Sarah Perman, an early investigator committed to improving outcomes from out-of-hospital cardiac arrest. In this extension, we will continue a pilot trial of the Tool to EMPOwer (TEMPO) Surrogate Decision Makers of comatose survivors of cardiac arrest at the University of Colorado Hospital. This pilot is intended to determine feasibility and acceptability of the tool as well as knowledge transferred regarding post-cardiac arrest care. We intend to utilize the pilot trial to prepare for widespread implementation of TEMPO. The results of the pilot trial will further inform the design of a multi- center pragmatic clinical trial to implement the educational tool in order to encourage guideline concordant post-cardiac arrest care including delayed neuro-prognostication and delayed withdrawal of life-sustaining therapy. Overall, we hypothesize that informing surrogate decision makers on guideline concordant care, will result in delayed decisions to withdraw life-sustaining therapy and allow the post-arrest patient adequate timing for appropriate neuro-prognostication and awakening, thus improving outcomes from out-of-hospital cardiac arrest. This will be the subject of a future independent research proposal by the applicant.