Improving Outcomes after Pediatric Cardiac Arrest

改善小儿心脏骤停后的预后

• 批准号: 9243302
• 负责人: Robert Michael Sutton
• 金额: $ 81.54万
• 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 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9243302
• 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; Effectiveness; Emergency Situation; Environment; Environmental air flow; Event; Failure; Funding; Future; Goals; Guidelines; Health Personnel; Heart; Heart Arrest; Hospitalized Child; Hospitals; 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; Research Infrastructure; Respiratory Failure; Resuscitation; Shock; Structure; System; Training; congenital heart disorder; cost; design; effectiveness trial; efficacy study; efficacy trial; improved; improved outcome; multidisciplinary; novel; novel strategies; point of care; public health relevance; skills training; success; survival outcome

 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）：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发原因。虽然心脏骤停的生存率在过去十年中有所改善，但这些儿童中有一半以上无法活到出院。由于脑损伤使幸存者的护理复杂化，这些儿童和公众健康的负担是巨大的。 心肺复苏术（CPR）-在心脏骤停期间提供胸部按压和通气的医疗程序-是拯救生命的，更高质量的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。通过传统的培训方法来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CPR的质量和结果。 本研究的目的是确定在单中心重症监护室（ICU）有效性研究中改善结局的新型复苏护理改善组合是否可推广到多中心有效性试验中的其他儿科机构。ICU复苏（ICU-RESUS）包包括：1）护理点的CPR培训（在ICU而不是远离患者的教室）; 2）每次心脏骤停的跨学科结构化审查，强调以患者为中心的生理学，旨在优化骤停期间和骤停后护理。ICU-RESUS捆绑包大大提高了CPR质量，并在单中心疗效试验期间使事件存活的儿童数量增加了近一倍。在本申请中，提出了一项多机构阶梯楔形群随机试验，该试验利用了国立儿童健康与人类发展研究所（NICHD）资助的合作儿科重症监护研究网络（CPCCRN）的现有基础设施，其目的如下：1）评价ICU-RESUS干预束对改善ICU心脏骤停治疗儿童的结局的有效性;以及2）评价ICU-RESUS干预束在改善ICU医疗保健提供者在ICU心脏骤停治疗儿童人群中提供的CPR质量方面的有效性。 本研究的目的是建立一个跨学科的复苏护理包，提高心肺复苏术的质量和结果的儿童谁有ICU心脏骤停。拟议的R 01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。