Improving Care After Cardiac Arrest by Informing Surrogate Decision Makers - Extension

通过通知代理决策者来改善心脏骤停后的护理 - 扩展

基本信息

批准号：
10406548
负责人：
Sarah M Perman
金额：
$ 6.74万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-18 至 2022-03-09
项目状态：
已结题

项目摘要

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 COVID extension will pilot test 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. In this extension, we will continue a pilot trial of the Tool to EMPOwer (TEMPO) Surrogate Decision Makers of comatose survivors of cardiac arrest at the University of Colorado Hospital. This pilot is intended to determine feasibility and acceptability of the tool as well as knowledge transferred regarding post-cardiac arrest care. We intend to utilize the pilot trial to prepare for widespread implementation of TEMPO. 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 independent research proposal by the applicant.

项目摘要 – 通过通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着差异。协调护理与心脏骤停的总体结果差异相关。遵循相关指南，神经功能恢复良好的生存率会得到改善。美国各医院延迟决定撤回生命支持的原因差异很大。过早退出生命维持治疗包括对国家和国际指南的了解不足，家人对早期结果预测的要求，以及家人对重症监护的不完全理解。为了鼓励使用指南一致的延迟神经预测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教育方法；并向代理决策者通报神经预后的不确定性和指南一致护理。该职业发展奖中提出的研究新冠病毒扩展将试点测试一种新颖的干预措施将鼓励改进对神经预测和延迟 WLST 的指南遵守以及支持 Sarah Perman 博士的持续发展，她是一位致力于改进的早期研究者在此扩展中，我们将继续对该工具进行试点试验，以评估院外心脏骤停的结果。 EMPOwer (TEMPO) 大学心脏骤停昏迷幸存者的代理决策者科罗拉多医院。该试点旨在确定该工具的可行性和可接受性。我们打算利用试点试验为心脏骤停后护理做好准备。 TEMPO 的广泛实施将进一步为多用途的设计提供信息。中心务实的临床试验实施教育工具，以鼓励指南一致心脏骤停后护理，包括延迟神经预测和延迟停止生命维持总体而言，我们致力于向替代决策者通报指导一致护理，将导致延迟做出撤回生命维持治疗的决定，并为逮捕后的患者提供足够的时间进行适当的神经预测和唤醒，从而改善院外心脏病的结果这将是申请人未来独立研究提案的主题。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Overcoming Fears to Save Lives: COVID-19 and the Threat to Bystander CPR in Out-of-Hospital Cardiac Arrest.

DOI：
10.1161/circulationaha.120.048909
发表时间：
2020-09-29
期刊：
Circulation
影响因子：
37.8
作者：
Perman SM
通讯作者：
Perman SM

Physician decision processes in post-cardiac arrest care: Can we describe how we decide?

心脏骤停后护理中的医生决策过程：我们能描述一下我们是如何决策的吗？

DOI：
10.1016/j.resuscitation.2022.02.013
发表时间：
2022
期刊：
Resuscitation
影响因子：
6.5
作者：
Perman,SarahM
通讯作者：
Perman,SarahM

Impact of the COVID-19 pandemic on cardiac arrest systems of care.

DOI：
10.1097/mcc.0000000000000817
发表时间：
2021-06-01
期刊：
Current opinion in critical care
影响因子：
3.3
作者：
Kovach CP;Perman SM
通讯作者：
Perman SM

EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest.

DOI：
10.1097/ta.0000000000001945
发表时间：
2018-07
期刊：
The journal of trauma and acute care surgery
影响因子：
0
作者：
Hsu CH;Haac BE;Drake M;Bernard AC;Aiolfi A;Inaba K;Hinson HE;Agarwal C;Galante J;Tibbits EM;Johnson NJ;Carlbom D;Mirhoseini MF;Patel MB;OʼBosky KR;Chan C;Udekwu PO;Farrell M;Wild JL;Young KA;Cullinane DC;Gojmerac DJ;Weissman A;Callaway C;Perman SM;Guerrero M;Aisiku IP;Seethala RR;Co IN;Madhok DY;Darger B;Kim DY;Spence L;Scalea TM;Stein DM
通讯作者：
Stein DM

Young at Heart: Examining the Incidence and Etiology of Sudden Cardiac Death in the Young.