Post-Resuscitation Care and Survival After In-hospital Cardiac Arrest

院内心脏骤停后的复苏后护理和生存

• 批准号: 8679133
• 负责人: Saket Girotra
• 金额: $ 12.55万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8679133
• 关键词: Accounting; Affect; Aftercare; Algorithms; American Heart Association; Attention; Beds; Belief; Cardiopulmonary Resuscitation; Caring; Cessation of life; Characteristics; Chest; Coma; Communication; Data; Development; Discipline of Nursing; Effectiveness; Elements; Foundations; Future; Guidelines; Health Services Research; Heart; Heart Arrest; Hospitalization; Hospitals; Human Resources; Intensive Care Units; Intervention; Investigation; Knowledge; Leadership; Learning; Length of Stay; Literature; Meta-Analysis; Methods; Modeling; Myocardial; Nervous System Trauma; Neurologic; Outcome; Patients; Performance; Phase; Process; Protocols documentation; Registries; Research; Research Project Grants; Resuscitation; Risk Estimate; Science; Societies; Structure; Sudden Death; Surveys; Survival Rate; Survivors; Therapeutic; Therapeutic Intervention; Time; Training; United States; Variant; Work; cost; design; disability; experience; improved; informant; innovation; insight; interest; natural hypothermia; percutaneous coronary intervention; public health relevance; response; systematic review

DESCRIPTION (provided by applicant): In-hospital cardiac arrests are a common and lethal problem, accounting for approximately 160,000 deaths every year in the United States. Previous efforts to improve cardiac arrest outcomes have largely focused on pre-arrest (e.g., rapid response teams) and intra-arrest factors (e.g., quality of cardiopulmonary resuscitation [CPR]); much less emphasis has been placed on post-arrest factors or post-resuscitation care. Yet, nearly 50% of all deaths due to a cardiac arrest occur during the post-resuscitation phase and there is widespread belief that survival can be improved substantially. The importance of the post-resuscitation phase has been recently recognized by professional societies like the American Heart Association. However, our understanding of the critical elements of post-resuscitation care that might improve patient outcomes remains severely limited; we do not understand precisely which therapies, protocols and organizational factors are effective. The research proposed in this application has been designed to advance the science and knowledge regarding post- resuscitation care as well as support the continued development of Dr. Saket Girotra- an extremely promising cardiologist with interest and training in health services research. Aim 1 will involve a systematic review of the existing literature to comprehensively synthesize all interventions (therapies, processes of care, organizational interventions) that have been studied for improving survival during the post-resuscitation phase. The available evidence will be systematically synthesized using both qualitative and quantitative (e.g., meta-analysis) methods. Aim 2 will examine hospital-level variation in post-resuscitation survival using data from the Get With The Guidelines-Resuscitation (GWTG-Resuscitation) registry. Using hierarchical models, we will estimate risk- adjusted rates of post-resuscitation survival at each hospital. We will identify hospitals with exceptionally good survival rates (high-performing hospitals) using a deviance approach. This work will lay the foundation of our efforts to identify specific practices at high-performing hospitals that allow them to achieve superior outcomes. Aim 3 will involve development and implementation of a survey of key informants at participating hospitals in GWTG-Resuscitation to obtain detailed information regarding hospital-specific post-resuscitation care practices. The survey will allow us to identify which specific strategies are used by high performing hospitals that allow them to achieve their exceptional outcomes. We hypothesize that these strategies will be multi- faceted and include specific treatments, processes of care, personnel, as well as organizational factors (e.g., leadership, communication). Identifying strategies that are most effective in improving post-resuscitation care ("best practices") will inform on the design of a quality improvement intervention geared towards improving post -resuscitation care at all hospitals. This will be the subject of a future R01 by the applicant.

描述(由申请人提供)：院内心脏骤停是一个常见的致命问题，在美国每年约有16万人死亡。以往改善心脏骤停结果的努力主要集中在心脏骤停前(例如，快速反应小组)和心脏骤停内因素(例如，心肺复苏的质量[CPR])；对心脏骤停后因素或复苏后护理的重视要少得多。然而，所有因心脏骤停而导致的死亡中，近50%发生在复苏后阶段，人们普遍认为，存活率可以大幅提高。复苏后阶段的重要性最近得到了像美国心脏协会这样的专业协会的认可。然而，我们对复苏后护理中可能改善患者预后的关键因素的了解仍然严重受限；我们不确切地了解哪些治疗方法、方案和组织因素是有效的。本申请中提出的研究旨在促进有关复苏后护理的科学和知识，并支持Saket Girotra博士的持续发展，他是一位非常有前途的心脏病专家，对卫生服务研究感兴趣并接受过培训。目标1将涉及对现有文献的系统审查，以全面综合所有已被研究的在复苏后阶段提高存活率的干预措施(治疗、护理过程、组织干预)。将使用定性和定量(例如，荟萃分析)方法系统地综合现有证据。目标2将使用GET与指南-复苏(GWTG-Resusciting)登记的数据来检查复苏后存活率在医院水平的变化。使用分层模型，我们将估计每家医院复苏后存活率的风险调整后比率。我们将使用偏差方法确定存活率特别高的医院(高绩效医院)。这项工作将为我们的努力奠定基础，以确定高绩效医院的具体做法，使它们能够取得更好的结果。目标3将涉及在参与GWTG-复苏的医院对主要信息者进行调查，以获得有关医院具体复苏后护理做法的详细信息。这项调查将使我们能够确定高绩效医院使用了哪些具体战略来实现其非凡的结果。我们假设这些战略将是多方面的，包括具体的治疗、护理过程、人员以及组织因素(例如，领导力、沟通)。确定在改善复苏后护理方面最有效的战略(“最佳做法”)将有助于设计旨在改善所有医院复苏后护理的质量改进干预措施。这将是申请者未来R01的主题。