Improving Outcomes after Pediatric Cardiac Arrest

 描述(申请人提供)：儿科心脏骤停每年影响数千名住院儿童。进行性心肺衰竭是大多数此类事件的诱因。虽然心脏骤停的生存结果在过去十年中有所改善，但这些儿童中有一半以上将不会活到出院。由于脑损伤使幸存下来的人的护理复杂化，这些儿童和公众的健康负担是巨大的。心肺复苏术(CPR)-在心脏骤停期间提供胸部按压和呼吸机的医疗程序-是拯救生命的，质量更高的CPR在这方面更有效。然而，在儿童复苏期间提供高质量的护理是困难的。通过传统培训方法改善护理的尝试并不成功；因此，需要采取干预措施来提高儿科心肺复苏的质量和结果。本研究的目的是确定在单中心重症监护病房(ICU)疗效研究中改善结果的新的复苏护理改进包是否可在多中心有效性试验中推广到其他儿科机构。ICU-RESUS(ICU-RESUS)捆绑包包括：1)在护理点(在ICU而不是远离患者的教室)进行CPR培训；以及2)对每一次心脏骤停进行跨学科的结构化审查，强调以患者为中心的生理学，旨在优化停跳内和停跳后的护理。在单中心疗效试验中，ICU-RESUS捆绑显著提高了CPR质量，并使事件中幸存下来的儿童数量几乎翻了一番。在这项应用中，利用美国国家儿童健康与人类发展研究所(NICHD)资助的儿科重症监护协作性研究网络(CPCCRN)的现有基础设施，提出了一项多机构阶梯式楔形群随机试验，目的如下：1)评估ICU-RESUS介入性捆绑对改善因ICU心脏骤停接受治疗的儿童结局的有效性；以及2)评估ICU-RESUS介入性捆绑对提高ICU医疗保健提供者在接受ICU心脏骤停治疗的儿童群体中提供的CPR质量的有效性。这项研究的目的是确定一个跨学科的复苏护理捆绑包可以改善ICU心脏骤停儿童的CPR质量和预后。拟议的R01应用程序将在短期内拯救生命，并最终通过影响美国心脏协会的儿童紧急心血管护理指南，改善未来为数千名住院儿童提供的护理。

 DESCRIPTION (provided by applicant): Pediatric cardiac arrest affects thousands of hospitalized children each year. Progressive heart and lung failure is a predisposing cause in the majority of these events. While cardiac arrest survival outcomes have improved over the last decade, more than half of these children will not live to hospital discharge. As brain injury complicates care in those who do survive, the burden to these children and the public's health is substantial. Cardiopulmonary resuscitation (CPR) - the medical procedure of providing chest compressions and ventilations during cardiac arrest - is lifesaving, and higher quality CPR is more effective at doing so. However, providing high quality care during the resuscitation of a child is difficult. Attempts to improve care through conventional training methods have not been successful; therefore, interventions to improve the quality of pediatric CPR and outcomes are needed. The objective of this study is to determine if a novel resuscitation care improvement bundle that improved outcomes in a single center intensive care unit (ICU) efficacy study is generalizable to other pediatric institutions in a multi-center effectiveness trial. The ICU-Resuscitation (ICU-RESUS) bundle includes: 1) CPR training at the point-of-care (in the ICU rather than a classroom away from patients); and 2) interdisciplinary structured reviews of each cardiac arrest that emphasize patient-centric physiology intended to optimize intra- arrest and post-arrest care. The ICU-RESUS bundle substantially improved CPR quality and nearly doubled the number of children surviving their event during the single center efficacy trial. In ths application, a multi- institutional stepped-wedge cluster-randomized trial, which leverages the existing infrastructure of the National Institute of Child Health and Human Development (NICHD)-funded Collaborative Pediatric Critical Care Research Network (CPCCRN), is proposed with the following aims: 1) Evaluate the effectiveness of the ICU-RESUS interventional bundle to improve outcomes of children treated for an ICU cardiac arrest; and 2) Evaluate the effectiveness of the ICU-RESUS interventional bundle to improve the quality of CPR provided by ICU healthcare providers in the population of children treated for an ICU cardiac arrest. The goal of this investigation is to establish that an interdisciplinary resuscitaion care bundle improves CPR quality and outcomes of children who have an ICU cardiac arrest. The proposed R01 application will save lives in the short term, and ultimately by influencing the American Heart Association's Emergency Cardiovascular Care Guidelines for children, improve the care provided to thousands of hospitalized children in the future.