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

描述（由申请人提供）：院内心脏骤停是一种常见且致命的问题，在美国每年约有160，000人死亡。先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）和逮捕内因素（例如，心肺复苏术[CPR]的质量）;对心脏骤停后因素或复苏后护理的重视要少得多。然而，由于心脏骤停导致的所有死亡中有近50%发生在复苏后阶段，并且人们普遍认为生存率可以大幅提高。复苏后阶段的重要性最近已被美国心脏协会等专业协会所认识。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理解仍然非常有限;我们不确切了解哪些疗法、方案和组织因素是有效的。本申请中提出的研究旨在促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性综述，以全面综合所有已研究用于提高复苏后阶段生存率的干预措施（治疗、护理过程、组织干预措施）。现有证据将采用定性和定量方法进行系统综合（例如，元分析）方法。 目标2将使用来自复苏指南（GWTG-复苏）登记处的数据检查复苏后生存率的医院水平差异。使用分层模型，我们将估计每家医院复苏后的风险调整生存率。我们将使用偏差方法来确定生存率非常好的医院（高绩效医院）。这项工作将奠定基础，我们的努力，以确定具体的做法，在高性能的医院，使他们能够实现上级的结果。 目标3将涉及在GWTG-复苏参与医院制定和实施一项关键知情人调查，以获得有关医院特定复苏后护理实践的详细信息。这项调查将使我们能够确定哪些具体的战略是由高性能的医院，使他们能够实现其特殊的结果。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（例如，领导力、沟通）。确定在改善复苏后护理方面最有效的策略（“最佳实践”）将为所有医院旨在改善复苏后护理的质量改善干预措施的设计提供信息。这将是申请人未来R 01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.