Multi-center observational study of the relationship of ventilation and outcomes from cardiac arrest using existing data

项目摘要/摘要 简介：院外心脏骤停是影响350,000多人的重大公共卫生问题。 美国每年都有成年人。尽管前景看好，但来自uchA的存活率仍然低得令人无法接受 在过去十年中取得的进展。在心脏骤停期间，所有的循环都停止。迅速恢复循环和 心脏和脑等重要器官的氧合是院外心脏骤停的重要目标 (UchA)复苏。心肺复苏(CPR)结合了胸部按压和肺充气 以恢复身体的血液灌流和氧气供应。在过去的十年里，研究的重点是测量 心肺复苏期间的胸部按压已导致胸部按压性能的改善和 提高了存活率。然而，在CPR研究中，通气量长期以来一直是一个被忽视的参数 部分是因为在心肺复苏和心肺复苏期间测量通气量是困难的。为了解决这个问题，我们开发了 一种利用胸部生物阻抗(电阻)测量心肺复苏期间通气量的新方法 可以通过在心肺复苏期间放置的除颤器垫进行监测。使用来自复苏的数据 结果达拉斯-沃斯堡网站，我们表明良好的通风质量与 改善结果，如存活到出院。然而，多中心研究是必要的，以 建立这些发现的概括性。 目的：测量通气量并确定标准通气量与通气量的关系 心肺复苏术的预后，如存活到出院和存活有良好的神经学结果 患有嗜酸性粒细胞缺乏症的患者。 方法：这项研究将使用世界上最大的、综合性的uchA多中心试验之一的数据。 ROC持续胸部按压(CCC)试验数据库包括CPR复苏指标、患者 结果和获得除颤器生物阻抗记录，这是心脏骤停的罕见组合 数据库。一种识别可接受的生物阻抗换气波形的有效方法已经被 被编程到自动计算机算法中，该算法将从除颤器中提取通风数据 来自六个参与CCC试验的ROC站点的约4,000名患者的录音。通风 数据将与每个病例的临床数据进行匹配。 具体目标：1)确定换气频率、发生率、潮气量、吸气和呼气 来自六个参与中华民国地区临床地点的30：2 CPR除颤器文件的时间。2)确定是否 使用袋式口罩装置进行通风期间的通风频率、发生率和分数与 30：2心肺复苏组的生存结果。3)比较CCC试验中30：2组和CCC组的结果。 意义：结果可能为范式转变提供证据，并影响CPR培训、指南和 未来每年向美国数十万人提供复苏护理。

Project Summary/Abstract Introduction: Out-of-hospital cardiac arrest (OHCA) is a major public health problem that affects over 350,000 adults in the United States each year. Survival from OHCA remains unacceptably low despite promising advances over the last decade. During cardiac arrest, all circulation stops. Quickly restoring circulation and oxygenation to vital organs such as the heart and brain are important goals of out of hospital cardiac arrest (OHCA) resuscitation. Cardiopulmonary resuscitation (CPR) combines chest compressions with lung inflation to restore perfusion and oxygenation to the body. During the past decade, research focused on measuring chest compressions during CPR has lead to improvements in performance of chest compressions and increased survival rates. However, ventilation has long been a “neglected parameter” in CPR research, in part, because measuring ventilation during OHCA and CPR is difficult. To address this problem, we developed a novel method for measuring ventilation during CPR using thoracic bioimpedance (electrical resistance), which can be monitored through defibrillator pads placed during CPR. Using data from the Resuscitation Outcomes Consortium Dallas-Fort Worth site, we showed that good quality ventilation is associated with improved outcomes such as survival to hospital discharge. However, a multi-center study is necessary to establish the generalizability of those findings. Objectives: To measure ventilation metrics and to determine the association of ventilation during standard CPR with outcomes such as survival to hospital discharge and survival with favorable neurological outcome in patients suffering OHCA. Methods: The study will use data from one of the largest, comprehensive OHCA multi-center trial in the world. The ROC Continuous Chest Compression (CCC) Trial database includes CPR resuscitation metrics, patient outcomes, and access to defibrillator bioimpedance recordings, a rare combination for a cardiac arrest database. A validated method to identify acceptable bioimpedance ventilation waveforms has been programmed into an automated computer algorithm, which will extract ventilation data from defibrillator recordings from approximately 4,000 patients from six ROC sites that participated in the CCC Trial. Ventilation data will be matched with clinical data for each case. Specific Aims: 1) To determine ventilation frequency, incidence, tidal volume, and inspiratory and expiratory times from the 30:2 CPR defibrillator files of six participating ROC regional clinical sites. 2) To determine if ventilation frequency, incidence, and fraction during ventilation with a bag-mask device is associated with survival outcomes in the 30:2 CPR group. 3) Compare outcomes of the 30:2 vs. CCC groups of the CCC Trial. Significance: The results may provide evidence for a paradigm shift and impact CPR training, guidelines, and the future delivery of resuscitation care to hundreds of thousands of people annually in the United States.