Cardiac Arrest: Improving CPR Quality and Survival

描述（由申请人提供）： 心脏骤停仍然是发达国家的头号杀手， 心肺复苏术（CPR）和心脏除颤已经超过50年了。仅在美国，每年就有超过30万人受到心脏骤停的折磨，尽管经常进行广泛的复苏努力，但只有不到10%的患者在事件中幸存下来。在动物研究和一些主观的人类观察报告中，良好的心肺复苏术的生存益处得到了很好的记录，但关于实际心脏骤停期间心肺复苏术质量的客观数据很少。最近的研究已经挑战了心肺复苏术是根据既定的共识指南统一执行的概念。此外，模拟研究表明，对CPR表现的音频反馈可以提高质量。我们小组和其他使用新型监测技术的人员最近的工作表明，多个CPR参数的质量不一致，并且通常福尔斯达不到指南建议，即使是由训练有素的医务人员执行。我们假设，复苏的表现是有限的各种人为因素，包括在逮捕和注意力不集中的任务性能差的团队领导建立。我们进一步假设，实时自动监测心肺复苏术与频繁的音频和视频反馈给救援人员将提高心肺复苏术的性能的质量。我们将测量人为因素参数，如团队领导和任务分配在医院心脏骤停通过直接观察训练有素的研究者。通过仔细研究复苏团队功能的人为因素，我们将能够通过针对导致绩效不佳的缺陷来影响CPR教育和培训。使用带有专门的CPR传感器和音频反馈提示的监护仪/除颤器，我们将分析反馈是否改善了CPR性能，然后将确定CPR质量改善的患者是否实现了生存率的改善。使用这种令人兴奋的新监测和反馈模式，我们希望建立一个最佳CPR性能方法的标准，这将广泛影响医院和社区心脏骤停患者的健康和生存。

DESCRIPTION (provided by applicant): Cardiac arrest remains the number one killer in the developed world, despite the introduction of cardiopulmonary resuscitation (CPR) and defibrillation over 50 years ago. In the U.S. alone, cardiac arrest afflicts over 300,000 people each year, with less than 10% of patients surviving the event despite often extensive resuscitative efforts. The survival benefit of well-performed CPR is well documented in animal studies and several subjective human observational reports, but little objective data exists regarding CPR quality during actual cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established consensus guidelines. In addition, simulation studies have suggested that audio feedback on CPR performance may improve quality. Work from our group and others using novel monitoring technology has recently shown that the quality of multiple CPR parameters is inconsistent and often falls short of guideline recommendations, even when performed by well-trained medical personnel. We hypothesize that resuscitation performance is limited by a variety of human factors including poor establishment of team leadership at the arrest and poor attention to task performance. We further hypothesize that real-time automatic monitoring of CPR with frequent audio and visual feedback to rescuers will improve the quality of CPR performance. We will measure human factor parameters such as team leadership and task assignment during in-hospital cardiac arrests via direct observation by trained investigators. By careful study of the human factors of resuscitation team function, we will be able to impact CPR education and training by targeting deficiencies leading to poor performance. Using monitor/defibrillators with specialized CPR sensors and audio feedback prompts, we will assay whether CPR performance is improved by feedback, and will then determine in patients with improved CPR quality, whether an improvement in survival is achieved. Using this exciting new monitoring and feedback modality, we hope to establish a standard for optimal CPR performance methodology that would broadly impact the health and survival of patients who suffer from cardiac arrest both in the hospital and the community.