Improving the Quality of In-hospital Pediatric Resuscitation

提高院内儿科复苏质量

• 批准号: 8326706
• 负责人: Robert Michael Sutton
• 金额: $ 12.12万
• 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/8326706
• 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; response; success

Candidate: 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.

候选人：Robert Michael萨顿博士是宾夕法尼亚大学（UPenn）麻醉、重症监护和儿科学助理教授，也是费城儿童医院（CHOP）的儿科重症监护主治医师，他正在申请一项指导性的以患者为导向的研究职业发展奖（K23）。该候选人具有学术和研究卓越的既定记录，本申请中提出的调查是他在评估CPR质量方面不断增长的专业知识的自然发展。候选人将进行一项前瞻性干预性试验，评估医院内儿科CPR的现有质量和自动视听反馈的呼吸机的有效性，以提高对美国心脏协会（AHA）儿科CPR指南的依从性。随后，通过儿科复苏研究的新分析方法，候选人将获得挑战现有CPR指南的数据，这些指南是通过专家共识使用可用的动物和成人数据开发的。这项调查将使候选人处于儿科CPR质量研究的最前沿，为未来的独立调查做好准备，并建立一个与他的导师互补但又不同的研究利基。 博士萨顿渴望成为一个独立的复苏科学家在一个领先的学术机构工作，超过75%的时间致力于以病人为导向的复苏研究。他的长期目标是领导一个专门致力于改善心肺复苏过程的研究团队，其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。 工作环境：职业发展计划和打算进行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。复苏研究专家已经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，并将继续合作，并从这个有才华的团体接受指导。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，候选人所能获得的环境，加上一个国际公认的成熟导师团队，几乎可以保证拟议的职业发展奖获得成功。 研究： 背景：儿童心脏骤停是一个主要的公共卫生问题。成人复苏期间医疗保健提供者CPR的质量通常不符合美国心脏协会（AHA）临床实践指南。具有视听反馈的CPR监测演示器改善了成人CPR质量和临床结果。同样的技术现在可以实际用于评估和改善年幼儿童的CPR指南依从性。 目的：描述住院儿科心脏骤停期间CPR质量的现状，确定视听反馈对改善现有基于共识的CPR指南依从性的影响，并开始挑战这些基于共识的指南实现与生存相关的可接受生理结局的范式。 研究设计：方案设计为前瞻性干预前后研究设计。在24个月的控制（“之前”）期间，将使用CPR监测仪记录儿科复苏期间进行的CPR的现有质量。干预（“之后”）期代表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指南的依从性的影响。在最后的探索性目标中，对现有指南的依从性将与动脉血压相关，以确定是否符合我们现有的基于共识的儿科CPR指南达到可接受的生理结果。 总结：建议及时和创新的调查将改变景观儿科复苏科学从证据贫乏到证据丰富的平台。所获得的信息丰富的数据，再加上正规的统计培训，在复苏研究的新方法，将把候选人在儿科CPR质量研究的最前沿。通过建立一个不同于他的导师的研究利基，候选人的职业生涯将为未来的独立研究调查做好准备，这些调查旨在改善患有心脏骤停的儿童的生活质量。