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

描述（由申请人提供）：医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。以前改善心脏骤停结果的努力主要集中在骤停前（例如，快速反应小组）和骤停内因素（例如，心肺复苏[CPR]的质量）；对骤停后因素或复苏后护理的重视要少得多。然而，近50%因心脏骤停导致的死亡发生在复苏后阶段，人们普遍认为存活率可以大大提高。复苏后阶段的重要性最近得到了美国心脏协会等专业协会的认可。然而，我们对可能改善患者预后的复苏后护理关键要素的理解仍然非常有限；我们并不确切地了解哪些疗法、方案和组织因素是有效的。本申请中提出的研究旨在推进复苏后护理的科学和知识，并支持Saket Girotra博士的持续发展，Saket Girotra博士是一位非常有前途的心脏病专家，对健康服务研究感兴趣并受过培训。目的1将涉及对现有文献的系统回顾，以全面综合所有干预措施（治疗、护理过程、组织干预），这些干预措施已被研究过，可提高复苏后阶段的生存率。将使用定性和定量（如荟萃分析）方法系统地综合现有证据。目的2将使用来自GWTG-Resuscitation注册表的数据，检查医院层面复苏后生存率的变化。使用分层模型，我们将估计各医院经风险调整后的复苏后存活率。我们将使用偏差方法确定生存率特别高的医院（高绩效医院）。这项工作将为我们努力确定高绩效医院的具体做法奠定基础，使他们能够取得更好的结果。目标3将涉及制定和实施一项对参与GWTG-Resuscitation的医院关键举报人的调查，以获得有关医院特定的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采用了哪些具体策略，使它们能够取得卓越的成果。我们假设这些策略将是多方面的，包括具体的治疗、护理过程、人员以及组织因素（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”）将为设计旨在改善所有医院复苏后护理的质量改进干预措施提供信息。这将是申请人未来R01的主题。

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.