Validation of Physiologic CPR Quality Using NOn-inVasive Waveform Analytics (CPR-NOVA)

项目摘要 儿童心脏骤停每年影响数以千计的儿童。进行性心肺衰竭是一种 这些事件中的许多都是诱因。尽管在过去的两年中生存结果有所改善 几十年来，这些儿童中仍有一半以上无法存活。由于新的脑损伤使患者的护理复杂化 对于幸存者来说，这些儿童和公众的健康负担是巨大的。 心肺复苏(CPR)-提供胸部按压和 心脏骤停时的呼吸--挽救生命，高质量的CPR在这方面更有效。一 提高心肺复苏质量的方法是通过使用心肺复苏质量监测除颤器。通过提供真正的- 心肺复苏力学指标的时间反馈，如胸部按压深度和速度，它们代表了最好的 目前提供的患者护理选项可提高CPR性能。不幸的是，这些设备中的大多数是 要么不被批准用于儿童，要么使用对许多儿科患者来说太大的护垫。因此，当前 技术限制了有意义的CPR质量监测的好处，只有一小部分儿童 心脏骤停。鉴于儿童心肺复苏质量和结果之间的强烈关联，新的方法 迫切需要监测心肺复苏质量，以改善对这一弱势群体的护理。 生理性心肺复苏术是一种很有前途的技术，它利用患者的血流动力学反应来 指导正在进行的复苏工作。这种方法克服了现有CPR的技术限制 通过使用患者监护仪的数据进行质量监测技术。不幸的是，因为很多病人都这样做 由于在心跳骤停时没有动脉内导管来指导心肺复苏，其临床影响有限。至 克服这一限制，此辅助应用程序的目标是利用 国家儿童健康与人类发展研究所资助的协作性儿科危重护理 研究网络(CPCCRN)和国家心脏、肺、 和血液研究所资助的家长R01-ICU-复苏(ICU-REUS)项目-验证两个 适用于几乎所有儿科心脏骤停的无创生理性CPR监护仪：1)呼气末二氧化碳 二氧化碳(ETCO2)；和2)通过脉搏血氧仪获得的光体积描记(PPG)。使用复杂的 基于机器学习方法，提出了一种前瞻性的观察性分析研究 目的：1)在接受至少1分钟的心肺复苏的儿童中，评估ETCO2作为无创性CPR质量监测仪 CPCCRN重症监护病房的CPR；以及2)使用新的机器学习分类算法，评估 PPG和其他候选生理波形作为无创性CPR质量监测仪。 通过利用CPCCRN的强大基础设施，新的血液动力学波形数据库 ICU-RESUS和高级机器学习分析，这次提交代表着一个独特的机会 验证两种儿科无创生理性CPR质量监测仪，以改善临床护理和挽救生命。好了！

Project Abstract Pediatric cardiac arrest affects thousands of children each year. Progressive heart and lung failure is a predisposing cause in many of these events. Despite improvements in survival outcomes over the past two decades, more than half of these children still do not survive. As new brain injury complicates care among survivors, 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 – saves lives, and higher quality CPR is more effective at doing so. One method to improve CPR quality is through the use of CPR quality monitoring defibrillators. By providing real- time feedback on CPR mechanics targets such as chest compression depth and rate, they represent the best patient care option currently available to improve CPR performance. Unfortunately, most of these devices are either not approved for children or use pads that are too large for many pediatric patients. Thus, current technology limits the benefit of meaningful CPR quality monitoring to a small percentage of the children who suffer a cardiac arrest. Given the strong association between pediatric CPR quality and outcomes, new methods to monitor CPR quality are urgently needed to improve the care of this vulnerable population. Physiologic-directed CPR is a promising technique that uses the hemodynamic response of the patient to guide the ongoing resuscitation effort. This approach overcomes the technological limitations of existing CPR quality monitoring technology by using data from patient monitors. Unfortunately, because many patients do not have intra-arterial lines in place at the time of arrest to guide CPR, its clinical impact has been limited. To overcome this limitation, the objective of this ancillary application is to leverage the existing infrastructure of the National Institute of Child Health and Human Development-funded Collaborative Pediatric Critical Care Research Network (CPCCRN) and the unique hemodynamic waveform database of the National Heart, Lung, and Blood Institute-funded parent R01 – the ICU-Resuscitation (ICU-RESUS) Project – to validate two noninvasive physiologic CPR monitors applicable to nearly every pediatric cardiac arrest: 1) end-tidal carbon dioxide (ETCO2); and 2) PhotoPlethysmoGraphy (PPG) obtained via pulse oximetry. Using sophisticated machine learning methods, a prospective observational analytic investigation is proposed with the following Aims: 1) Evaluate ETCO2 as a noninvasive CPR quality monitor among children receiving at least 1 minute of CPR in a CPCCRN intensive care unit; and 2) Using novel machine learning classification algorithms, evaluate PPG and other candidate physiologic waveforms as noninvasive CPR quality monitors. By leveraging the substantial infrastructure of the CPCCRN, the novel hemodynamic waveform database of ICU-RESUS, and advanced machine learning analytics, this submission represents a unique opportunity to validate two noninvasive physiologic pediatric CPR quality monitors to improve clinical care and save lives. !