Improving Outcomes after Pediatric Cardiac Arrest

改善小儿心脏骤停后的预后

• 批准号: 9898428
• 负责人: Robert Michael Sutton
• 金额: $ 65.34万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9898428
• 关键词: Affect; American Heart Association; Brain Injuries; Cardiopulmonary Resuscitation; Cardiovascular system; Caring; Chest; Child; Childhood; Clinical; Cluster randomized trial; Critical Care; Data; Disease; Environment; Event; Failure; Funding; Future; Goals; Guidelines; Health Personnel; Heart; Heart Arrest; Hospitalized Child; Hospitals; Infrastructure; Institution; Intensive Care Units; Interruption; Intervention; Intervention Trial; Investigation; Life; Lung; Manikins; Medical; Metabolic; Methods; Multicenter Trials; National Institute of Child Health and Human Development; Neurologic; Neurological outcome; Organ; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Pediatric Intensive Care Units; Physiology; Population; Principal Investigator; Procedures; Process; Provider; Public Health; Quality of Care; Research; Respiratory Failure; Resuscitation; Shock; Structure; System; Training; cardiac intensive care unit; cardiovascular emergency; congenital heart disorder; cost; design; effectiveness evaluation; effectiveness trial; efficacy study; efficacy trial; improved; improved outcome; multidisciplinary; novel; novel strategies; point of care; pragmatic trial; public health relevance; skills training; success; survival outcome; ventilation

 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.

 描述（由申请人提供）：小儿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发原因。虽然心脏骤停的生存结果在过去十年中有所改善，但其中一半以上的儿童无法存活到出院。由于脑损伤使幸存者的护理变得复杂，这些儿童和公众的健康负担巨大。 心肺复苏 (CPR) 是一种在心脏骤停期间提供胸外按压和通气的医疗程序，可以挽救生命，而高质量的心肺复苏更有效。然而，在儿童复苏期间提供高质量的护理很困难。通过传统培训方法改善护理的尝试并未成功；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) 疗效研究中改善结局的新型复苏护理改善方案是否可以推广到其他儿科机构的多中心有效性试验中。 ICU 复苏 (ICU-RESUS) 套餐包括： 1) 护理点心肺复苏培训（在 ICU，而不是远离患者的教室）； 2) 对每次心脏骤停进行跨学科结构化审查，强调以患者为中心的生理学，旨在优化心脏骤停期间和骤停后的护理。 ICU-RESUS 组合极大地提高了心肺复苏质量，并且在单中心疗效试验期间使幸存的儿童人数几乎增加了一倍。在本申请中，提出了一项多机构阶梯楔形整群随机试验，该试验利用国家儿童健康和人类发展研究所 (NICHD) 资助的儿科重症监护协作研究网络 (CPCCRN) 的现有基础设施，其目标如下： 1) 评估 ICU-RESUS 干预束的有效性，以改善 ICU 心脏病治疗儿童的预后 逮捕； 2) 评估 ICU-RESUS 干预组合的有效性，以提高 ICU 医疗保健提供者为接受 ICU 心脏骤停治疗的儿童群体提供的心肺复苏质量。 这项调查的目的是确定跨学科复苏护理组合可以提高 ICU 心脏骤停儿童的心肺复苏质量和结果。拟议的 R01 应用程序将在短期内挽救生命，并最终通过影响美国心脏协会的儿童心血管急救指南，改善未来为数千名住院儿童提供的护理。

项目成果

Implementation Science Research in Pediatric Critical Care Medicine.

儿科重症监护医学的实施科学研究。

• DOI: 10.1097/pcc.0000000000003335
• 发表时间: 2023
• 期刊: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
• 作者: Woods-Hill,CharlotteZ;Wolfe,Heather;Malone,Sara;Steffen,KatherineM;Agulnik,Asya;Flaherty,BrianF;Barbaro,RyanP;Dewan,Maya;Kudchadkar,SapnaR;ExcellenceinPediatricImplementationScience(ECLIPSE)forthePediatricAcuteLungInjury
• 通讯作者: ExcellenceinPediatricImplementationScience(ECLIPSE)forthePediatricAcuteLungInjury