Improving the Safety and Efficacy of Out-of-Hospital Pediatric Airway Management

项目总结： 我提议一个为期4年的导师研究培训计划，以成为儿科急救领域的领导者 关爱研究。我接受过急救医学住院医师培训，并接受过儿科急救培训 目前是俄勒冈健康与科学大学急诊医学助理教授。 我的研究重点是提高儿科患者院外护理的安全性。这项提案将重点放在 特别是在院外紧急情况下提高儿科呼吸道管理的安全性和 探讨声门上型气道置入器的疗效。我的职业发展计划将为我提供更高的 决策科学、定性研究、生物统计学、知情同意例外和临床试验方面的技能 对推动这个领域和我的职业生涯至关重要的设计。培训将通过正式的课程进行， 辅导性研究、体验式学习、重点阅读计划和科学会议。 这项建议的总体目标是测试声门上呼吸道装置是否优于 小儿院外呼吸道的气管插管和袋式瓣膜面罩呼吸机 管理层。气管插管是一种复杂而有创伤性的过程，是最常见的体外循环。 医院先进的呼吸道技术和医院的金标准。然而，高达50%的 医院儿科气管插管并发气管插管错位和/或 移位、缺氧、高碳酸血症或呼吸道结构受损。袋式气门面罩通风量较少 侵入性，但在医院外环境中具有挑战性，因为需要在移动的车辆中提供护理。 迫切需要一种新的方法，减少并发症并有效地氧合和 通风。这一建议的中心假设是理解声门上呼吸道 儿童手术室中常用的器械比气管内更有效 院外急诊呼吸道管理中的插管和袋式气门面罩呼吸机。为了测试 在这一假设下，我们将1)检查护理人员使用的声门上呼吸道装置在 模拟实验室和手术室环境；2)进行定性研究以了解决策 制定用于院外儿科呼吸道管理的流程，并确定潜在的障碍 实施声门上呼吸道装置；以及3)进行前瞻性观察研究，以确定 呼吸道管理策略对儿科门诊心肺复苏质量和用药的影响 医院心脏骤停。这项研究将有助于改善院外儿科的呼吸道管理 了解单个设备特征、提供商因素和临床环境如何影响疗效和 呼吸道管理技术的安全性。

Project Summary: I propose a 4-year mentored research training program to become a leader in the field of pediatric emergency care research. I am residency-trained in Emergency Medicine and fellowship-trained in Pediatric Emergency Medicine and am currently Assistant Professor of Emergency Medicine at Oregon Health & Science University. My research focuses on improving safety in the out-of-hospital care of pediatric patients. This proposal focuses specifically on improving the safety of pediatric airway management during out-of-hospital emergencies and studying the efficacy of supraglottic airway devices. My career development plan will provide me advanced skills in decision science, qualitative research, biostatistics, exception from informed consent, and clinical trial design that are critical to advance this field and my career. The training will come through formal coursework, mentored research, experiential learning, focused reading programs, and scientific meetings. The overall objective of this proposal is to test whether supraglottic airway devices are superior to endotracheal intubation and bag-valve-mask ventilation for out-of-hospital pediatric airway management. Endotracheal intubation, a complex and invasive procedure, is the single most common out-of- hospital advanced airway technique and the gold standard in the hospital. However, up to 50% of out-of- hospital pediatric endotracheal intubations are complicated by endotracheal tube misplacement and/or dislodgement, hypoxia, hypercapnia, or damage to airway structures. Bag-valve-mask ventilation is less invasive but challenging in the out-of-hospital environment given the need to provide care in a moving vehicle. There is critical need for a new approach that reduces complications and is effective in oxygenation and ventilation. The central hypothesis of this proposal is to understand whether supraglottic airway devices, commonly used in children in the operating room, are more effective than endotracheal intubation and bag-valve-mask ventilation for out-of-hospital emergency airway management. To test this hypothesis we will 1) examine the efficacy of supraglottic airway devices being used by paramedics in simulation lab and operating room environments; 2) conduct a qualitative study to understand the decision making process used in out-of-hospital pediatric airway management and identify potential barriers to implementation of supraglottic airway devices; and 3) conduct a prospective observational study to determine how the airway management strategy affects CPR quality and medication administration in pediatric out-of- hospital cardiac arrest. This research will help improve out-of-hospital pediatric airway management by helping understand how individual device characteristics, provider factors, and clinical context affect the efficacy and safety of airway management techniques.