Improving the Quality of In-hospital Pediatric Resuscitation

提高院内儿科复苏质量

• 批准号: 8145615
• 负责人: Robert Michael Sutton
• 金额: $ 12.19万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-20 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145615
• 关键词: Accident and Emergency department; Adult; American Heart Association; Anesthesia procedures; Anterior; Area; Award; Biometry; Blood Pressure; Cardiopulmonary Arrest; Chest; Child; Childhood; Clinical; Clinical Practice Guideline; Commit; Consensus; Consensus Development; Coupled; Critical Care; Data; Defibrillators; Development; Development Plans; Devices; Diastolic blood pressure; Effectiveness; Ensure; Environment; Epidemiologic Methods; Feedback; Fellowship; Foundations; Future; Goals; Guidelines; Health Personnel; Heart Arrest; Institution; Intervention; Investigation; K-Series Research Career Programs; Knowledge; Laboratories; Lead; Learning; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Nature; Outcome; Patients; Pediatric Hospitals; Pediatric Intensive Care Units; Pediatrics; Pennsylvania; Philadelphia; Physicians; Physiological; Play; Population; Process; Protocols documentation; Public Health; Quality of life; Research; Research Design; Resources; Resuscitation; Role; Science; Scientist; Students; System; Technology; Time; Training; Universities; Work; base; career; career development; clinical epidemiology; design; evidence base; evidence based guidelines; high risk; improved; innovation; mature animal; novel; novel strategies; patient oriented; professor; prospective; public health relevance; response; success

DESCRIPTION (provided by applicant): Dr. Robert Michael Sutton, Assistant Professor of Anesthesia, Critical Care, and Pediatrics at the University of Pennsylvania (UPenn), and Pediatric Critical Care Attending Physician at the Children's Hospital of Philadelphia (CHOP), is applying for a Mentored Patient-Oriented Research Career Development Award (K23). This candidate has an established record of academic and research excellence, and the investigation proposed in this application is a natural progression of his growing expertise in assessing CPR quality. The candidate will conduct a prospective interventional trial evaluating the existing quality of in-hospital pediatric CPR and the effectiveness of defibrillators with automated audiovisual feedback to improve compliance with American Heart Association (AHA) pediatric CPR guidelines. Subsequently, through an analytic approach novel to pediatric resuscitation research, the candidate will obtain data to challenge the existing CPR guidelines, which have been developed by expert consensus using available animal and adult data. This investigation will place the candidate at the forefront of pediatric CPR quality research, prime his career for future independent investigations, and establish a research niche that is complementary to yet distinct from his accomplished mentors. Dr. Sutton aspires to become an independent resuscitation scientist working in a leading academic institution with greater than 75% time committed to patient-oriented resuscitation research. His long term goal is to lead a research team focused specifically on improving CPR process with the overall goal of improving survival and quality of life outcomes for children who suffer a cardiopulmonary arrest. The candidate's career activities during this award have been selected to ensure his transition to independent resuscitation scientist. Environment: The career development plan and the intended research investigation build upon an existing network of research and mentorship already in place at the candidate's institution. Experts in resuscitation research have developed a clinical learning laboratory to study cardiac arrest. The candidate has played an integral role in the development of these networks and will continue to collaborate and receive mentorship from this talented group. As a student in the Center for Clinical Epidemiology and Biostatistics at UPenn, the candidate will continue training in epidemiologic methods, but will also have extensive statistical resources committed to the completion of the research investigation. In short, the environment available to the candidate coupled with an established and internationally recognized team of mentors, all but guarantee the success of the proposed career development award. Research: Context: Cardiac arrests in children are a major public health problem. The quality of healthcare provider CPR during adult resuscitations typically does not comply with American Heart Association (AHA) clinical practice guidelines. CPR monitoring defibrillators with audiovisual feedback improve adult CPR quality and clinical outcomes. This same technology can now practically be used to assess and improve CPR guideline compliance in younger children. Objective: Characterize the current landscape of CPR quality during in-hospital pediatric cardiac arrest, determine the effect of audiovisual feedback to improve compliance with the existing consensus-based CPR guidelines, and begin to challenge the paradigm that these consensus-based guidelines achieve acceptable physiologic outcomes associated with survival. Study Design: The design of the protocol is a prospective before-after interventional study design. The existing quality of CPR performed during pediatric resuscitations will be recorded using CPR monitoring defibrillators during a 24 month Control ("Before") Period. The Intervention ("After") Period represents a 24 month period during which the effect of audiovisual feedback to improve compliance with our existing consensus-based CPR guidelines will be determined. In a final exploratory aim, compliance with existing guidelines will be associated to arterial blood pressures to determine if compliance with our existing consensus-based pediatric CPR guidelines achieves acceptable physiologic outcome. Summary: The proposed timely and innovative investigation will change the landscape of pediatric resuscitation science from an evidence-poor to an evidence-rich platform. The informative data obtained coupled with formal statistical training in methods novel to resuscitation research, will place the candidate at the forefront of pediatric CPR quality research. By establishing a research niche distinct from his mentors, the candidate's career will be primed for future independent research investigations designed to improve quality of life outcomes for children who suffer a cardiac arrest. PUBLIC HEALTH RELEVANCE: The quality of healthcare provider CPR during adult resuscitations typically does not comply with American Heart Association (AHA) clinical practice guidelines. The goal of this investigation is to characterize the current landscape of CPR quality during in-hospital pediatric cardiac arrest, determine the effect of audiovisual feedback to improve compliance with the existing consensus-based CPR guidelines, and change the foundation of pediatric CPR guideline development from consensus-based to evidence-based. The knowledge obtained from the timely and innovative investigation will forever change the landscape of pediatric resuscitation from an evidence-poor to an evidence-rich platform.

描述（由申请人提供）：罗伯特·迈克尔·萨顿博士，宾夕法尼亚大学（UPenn）麻醉、重症监护和儿科助理教授，费城儿童医院（CHOP）儿科重症监护主治医师，正在申请指导患者导向研究职业发展奖（K23）。该候选人在学术和研究方面有着卓越的记录，本申请中提出的调查是他在评估心肺复苏术质量方面日益增长的专业知识的自然发展。候选人将进行一项前瞻性介入试验，评估现有的院内儿科心肺复苏术的质量和自动视听反馈除颤器的有效性，以提高对美国心脏协会（AHA）儿科心肺复苏术指南的依从性。随后，通过一种儿科复苏研究的新颖分析方法，候选人将获得数据来挑战现有的心肺复苏指南，这些指南是通过专家共识利用现有的动物和成人数据制定的。这项调查将使候选人处于儿科心肺复苏术质量研究的前沿，为他未来的独立研究奠定基础，并建立一个研究利基，与他有成就的导师互补，但又截然不同。萨顿博士渴望成为一名独立的复苏科学家，在领先的学术机构工作，有75%以上的时间致力于以患者为导向的复苏研究。他的长期目标是领导一个研究小组，专门研究改善心肺复苏过程，总体目标是提高心肺骤停儿童的生存率和生活质量。候选人在此奖项期间的职业活动已被选中，以确保他过渡到独立的复苏科学家。环境：职业发展计划和预期的研究调查建立在候选人所在机构现有的研究和指导网络的基础上。复苏研究专家开发了一个临床学习实验室来研究心脏骤停。候选人在这些网络的发展中发挥了不可或缺的作用，并将继续与这个有才华的团体合作并接受指导。作为宾夕法尼亚大学临床流行病学和生物统计学中心的学生，候选人将继续接受流行病学方法的培训，但也将拥有广泛的统计资源，致力于完成研究调查。简而言之，为候选人提供的环境，加上一个成熟的、国际认可的导师团队，几乎保证了拟议的职业发展奖的成功。研究：背景：儿童心脏骤停是一个主要的公共卫生问题。在成人复苏过程中，医疗保健提供者CPR的质量通常不符合美国心脏协会（AHA）临床实践指南。带有视听反馈的心肺复苏术监测除颤器可改善成人心肺复苏术质量和临床结果。同样的技术现在可以实际用于评估和提高幼儿心肺复苏术指南的依从性。目的：描述住院儿童心脏骤停期间心肺复苏术质量的现状，确定视听反馈对提高现有基于共识的心肺复苏术指南的依从性的影响，并开始挑战这些基于共识的指南能够实现与生存相关的可接受的生理结果的范式。研究设计：方案设计为前瞻性介入前后研究设计。在24个月的对照（“前”）期间，使用CPR监测除颤器记录儿科复苏期间实施的心肺复苏术的现有质量。干预期（“干预后”）指的是24个月的时间，在此期间，将确定视听反馈对改善我们现有的基于共识的CPR指导方针的依从性的效果。在最后的探索性目的中，将现有指南的依从性与动脉血压联系起来，以确定是否遵守我们现有的基于共识的儿科心肺复苏术指南获得了可接受的生理结果。摘要：提出的及时和创新的调查将改变儿科复苏科学从证据不足到证据丰富的平台。获得的信息数据加上对复苏研究新颖方法的正式统计培训，将使候选人处于儿科心肺复苏质量研究的前沿。通过建立一个与他的导师不同的研究利基，候选人的职业生涯将为未来的独立研究调查做好准备，这些调查旨在改善心脏骤停儿童的生活质量。