Cardiac Arrest: Improving CPR Quality and Survival

描述(由申请人提供)： 心脏骤停仍然是发达国家的头号杀手，尽管引入了 心肺复苏(CPR)和除颤已有50多年的历史。仅在美国，每年就有超过30万人遭受心脏骤停的折磨，尽管进行了广泛的复苏努力，但只有不到10%的患者幸存下来。良好的心肺复苏对生存的益处在动物研究和一些主观的人类观察报告中得到了很好的证明，但关于实际心脏骤停期间的心肺复苏质量的客观数据很少。最近的研究挑战了CPR是根据既定的共识指南统一进行的概念。此外，模拟研究表明，CPR性能的音频反馈可能会提高质量。我们小组和其他使用新监测技术的团队最近的工作表明，多个CPR参数的质量不一致，经常达不到指南建议，即使是由训练有素的医务人员进行的。我们假设，复苏绩效受到各种人为因素的限制，包括逮捕时团队领导力的建立不佳，以及对任务绩效的关注不足。我们进一步假设，实时自动监测CPR并向救援人员提供频繁的音频和视觉反馈将提高CPR的执行质量。我们将通过训练有素的研究人员的直接观察，测量住院心脏骤停期间的团队领导力和任务分配等人为因素参数。通过仔细研究复苏团队功能的人为因素，我们将能够针对导致绩效不佳的缺陷来影响CPR教育和培训。使用带有专门的CPR传感器和音频反馈提示的监护仪/除颤器，我们将测试通过反馈是否改善了CPR的性能，然后将确定在CPR质量改善的患者中，是否实现了生存的改善。使用这一令人兴奋的新监测和反馈模式，我们希望为最佳CPR执行方法建立一个标准，该方法将广泛影响医院和社区心脏骤停患者的健康和生存。

DESCRIPTION (provided by applicant): Cardiac arrest remains the number one killer in the developed world, despite the introduction of cardiopulmonary resuscitation (CPR) and defibrillation over 50 years ago. In the U.S. alone, cardiac arrest afflicts over 300,000 people each year, with less than 10% of patients surviving the event despite often extensive resuscitative efforts. The survival benefit of well-performed CPR is well documented in animal studies and several subjective human observational reports, but little objective data exists regarding CPR quality during actual cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established consensus guidelines. In addition, simulation studies have suggested that audio feedback on CPR performance may improve quality. Work from our group and others using novel monitoring technology has recently shown that the quality of multiple CPR parameters is inconsistent and often falls short of guideline recommendations, even when performed by well-trained medical personnel. We hypothesize that resuscitation performance is limited by a variety of human factors including poor establishment of team leadership at the arrest and poor attention to task performance. We further hypothesize that real-time automatic monitoring of CPR with frequent audio and visual feedback to rescuers will improve the quality of CPR performance. We will measure human factor parameters such as team leadership and task assignment during in-hospital cardiac arrests via direct observation by trained investigators. By careful study of the human factors of resuscitation team function, we will be able to impact CPR education and training by targeting deficiencies leading to poor performance. Using monitor/defibrillators with specialized CPR sensors and audio feedback prompts, we will assay whether CPR performance is improved by feedback, and will then determine in patients with improved CPR quality, whether an improvement in survival is achieved. Using this exciting new monitoring and feedback modality, we hope to establish a standard for optimal CPR performance methodology that would broadly impact the health and survival of patients who suffer from cardiac arrest both in the hospital and the community.