Improving Care after cardiac arrest by informing surrogate decision makers

项目总结-通过告知代理决策者来改善心脏骤停后的护理 心脏骤停后的生存率和神经功能恢复情况差异很大，部分原因是不一致的 成功复苏后的医院护理。在提供基于证据的指南方面存在显著差异 协调治疗与心脏骤停的总体结局差异相关。当准则 随访时，神经功能恢复良好的生存率提高。然而，遵守关于 在美国各医院中，延迟撤回生命支持的决定存在很大差异。归因于 早期停止生命维持治疗包括对国家和国际指南缺乏了解， 家属对早期预后预测的要求，以及家属对重症监护的不完全理解。在 为了鼓励使用指南一致的延迟神经传导和伴随的 停止生命维持治疗（复苏后>72小时），我们提出了一种新的方法;教育 并告知代理决策者神经预后的不确定性和指南一致性护理。的 这项职业发展奖中提出的研究旨在创造一种新的干预措施， 鼓励改善对神经系统损害和延迟WLST的指南依从性，并支持 Sarah Perman博士的持续发展，他是一位致力于改善 院外心脏骤停。目标1将利用定性方法， 为昏迷的心脏骤停后患者（医生、护士、代理决策者）制定决策， 确定知识差距，并确定指南一致心脏骤停后护理的障碍。目标2将 使我们能够开发和完善教育工具，以解决神经预后的不确定性和指导 和谐的逮捕后护理。利用心脏骤停专家小组和利益相关者焦点小组， 执行一个迭代过程，以完善工具并解决实施的潜在障碍。最后，在Aim 我们将在一个等效的时间样本准实验中对我们的教育工具进行试点测试， 科罗拉多大学医院急诊科的工具， 对院外心脏骤停患者进行复苏，以探讨广泛应用 实施.试点试验的结果将进一步为多中心实用临床研究的设计提供信息。 试验实施教育工具，以鼓励指导一致的心脏骤停后护理 包括延迟的神经刺激和延迟的生命维持治疗的撤回。总的来说，我们 假设告知代理决策者关于指南一致性护理，将导致延迟 决定撤回维持生命的治疗，并允许停搏后患者有足够的时间进行适当的 神经刺激和唤醒，从而改善院外心脏骤停的结果。这将 成为申请人未来R 01提案的主题。

PROJECT SUMMARY – Improving care after cardiac arrest by informing surrogate decision makers Survival and neurological recovery after cardiac arrest are highly variable, driven in part by inconsistent hospital care following successful resuscitation. Significant variability in delivery of evidence based, guideline concordant care has been associated with differences in overall outcome from cardiac arrest. When guidelines are followed, survival with good neurologic recovery is improved. However, adherence to guidelines regarding delayed decision to withdraw life support has been highly variable across US hospitals. Reasons attributed to early withdrawal of life sustaining therapy include poor knowledge of national and international guidelines, requests from family for early outcome predications, and incomplete family comprehension of critical care. In order to encourage utilization of guideline concordant delayed neuro-prognostication and concomitant withdrawal of life-sustaining therapy (>72 hours after resuscitation) we propose a novel approach; to educate and inform surrogate decision makers on neuro-prognostic uncertainty and guideline concordant care. The research proposed in this career development award is intended to create a novel intervention that will encourage improved guideline adherence on neuro-prognostication and delayed WLST as well as to support the continued development of Dr. Sarah Perman, an early investigator committed to improving outcomes from out-of-hospital cardiac arrest. Aim 1 will utilize qualitative methodology to interview key stakeholders in decision making for comatose post-cardiac arrest patients (physicians, nurses, surrogate decision makers) to identify knowledge gaps and determine barriers to guideline concordant post-cardiac arrest care. Aim 2 will allow us to develop and refine educational tools to address neuro-prognostic uncertainty and guideline concordant post-arrest care. Utilizing a panel of cardiac arrest experts and stakeholder focus groups we will perform an iterative process to refine the tools and address potential barriers to implementation. Finally, in Aim 3 we will pilot test our educational tools in an equivalent time-samples quasi-experiment where we implement the tools in the University of Colorado Hospital Emergency Department for surrogate decision makers of resuscitated out of hospital cardiac arrest patients to explore feasibility and acceptability for widespread implementation. The results of the pilot trial will further inform the design of a multi-center pragmatic clinical trial to implement the educational tool in order to encourage guideline concordant post-cardiac arrest care including delayed neuro-prognostication and delayed withdrawal of life-sustaining therapy. Overall, we hypothesize that informing surrogate decision makers on guideline concordant care, will result in delayed decisions to withdraw life-sustaining therapy and allow the post-arrest patient adequate timing for appropriate neuro-prognostication and awakening, thus improving outcomes from out-of-hospital cardiac arrest. This will be the subject of a future R01 proposal by the applicant.