Post-Resuscitation Care and Survival After In-hospital Cardiac Arrest

院内心脏骤停后的复苏后护理和生存

• 批准号: 8679133
• 负责人: Saket Girotra
• 金额: $ 12.55万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8679133
• 关键词: Accounting; Affect; Aftercare; Algorithms; American Heart Association; Attention; Beds; Belief; Cardiopulmonary Resuscitation; Caring; Cessation of life; Characteristics; Chest; Coma; Communication; Data; Development; Discipline of Nursing; Effectiveness; Elements; Foundations; Future; Guidelines; Health Services Research; Heart; Heart Arrest; Hospitalization; Hospitals; Human Resources; Intensive Care Units; Intervention; Investigation; Knowledge; Leadership; Learning; Length of Stay; Literature; Meta-Analysis; Methods; Modeling; Myocardial; Nervous System Trauma; Neurologic; Outcome; Patients; Performance; Phase; Process; Protocols documentation; Registries; Research; Research Project Grants; Resuscitation; Risk Estimate; Science; Societies; Structure; Sudden Death; Surveys; Survival Rate; Survivors; Therapeutic; Therapeutic Intervention; Time; Training; United States; Variant; Work; cost; design; disability; experience; improved; informant; innovation; insight; interest; natural hypothermia; percutaneous coronary intervention; public health relevance; response; systematic review

DESCRIPTION (provided by applicant): In-hospital cardiac arrests are a common and lethal problem, accounting for approximately 160,000 deaths every year in the United States. Previous efforts to improve cardiac arrest outcomes have largely focused on pre-arrest (e.g., rapid response teams) and intra-arrest factors (e.g., quality of cardiopulmonary resuscitation [CPR]); much less emphasis has been placed on post-arrest factors or post-resuscitation care. Yet, nearly 50% of all deaths due to a cardiac arrest occur during the post-resuscitation phase and there is widespread belief that survival can be improved substantially. The importance of the post-resuscitation phase has been recently recognized by professional societies like the American Heart Association. However, our understanding of the critical elements of post-resuscitation care that might improve patient outcomes remains severely limited; we do not understand precisely which therapies, protocols and organizational factors are effective. The research proposed in this application has been designed to advance the science and knowledge regarding post- resuscitation care as well as support the continued development of Dr. Saket Girotra- an extremely promising cardiologist with interest and training in health services research. Aim 1 will involve a systematic review of the existing literature to comprehensively synthesize all interventions (therapies, processes of care, organizational interventions) that have been studied for improving survival during the post-resuscitation phase. The available evidence will be systematically synthesized using both qualitative and quantitative (e.g., meta-analysis) methods. Aim 2 will examine hospital-level variation in post-resuscitation survival using data from the Get With The Guidelines-Resuscitation (GWTG-Resuscitation) registry. Using hierarchical models, we will estimate risk- adjusted rates of post-resuscitation survival at each hospital. We will identify hospitals with exceptionally good survival rates (high-performing hospitals) using a deviance approach. This work will lay the foundation of our efforts to identify specific practices at high-performing hospitals that allow them to achieve superior outcomes. Aim 3 will involve development and implementation of a survey of key informants at participating hospitals in GWTG-Resuscitation to obtain detailed information regarding hospital-specific post-resuscitation care practices. The survey will allow us to identify which specific strategies are used by high performing hospitals that allow them to achieve their exceptional outcomes. We hypothesize that these strategies will be multi- faceted and include specific treatments, processes of care, personnel, as well as organizational factors (e.g., leadership, communication). Identifying strategies that are most effective in improving post-resuscitation care ("best practices") will inform on the design of a quality improvement intervention geared towards improving post -resuscitation care at all hospitals. This will be the subject of a future R01 by the applicant.

描述（由申请人提供）：院内心脏骤停是一个常见且致命的问题，在美国，每年约为160,000人死亡。以前改善心脏骤停结果的努力主要集中在预处前（例如，快速响应小组）和逮捕因素（例如，心肺复苏的质量[CPR]）；在逮捕后因素或封闭后护理上的重点要少得多。然而，由于心脏骤停造成的所有死亡中，近50％发生在散发后阶段，并且人们普遍认为可以大大改善生存。诸如美国心脏协会等专业社会最近认可了引起后刺激阶段的重要性。但是，我们对可能改善患者预后的后刺激后护理的关键要素的理解仍然受到严重限制。我们不确定哪些疗法，方案和组织因素有效。本申请中提出的研究旨在推进有关复苏后护理的科学和知识，并支持Saket Girotra博士的持续发展 - 一位非常有前途的心脏病专家，对卫生服务研究有兴趣和培训。 AIM 1将涉及对现有文献进行系统的审查，以全面综合所有干预措施（治疗，护理过程，组织干预措施），这些干预措施已被研究以改善后震后的生存阶段。可用的证据将使用定性和定量（例如荟萃分析）方法系统合成。 AIM 2将使用GET中的数据（GWTG震荡）注册表来检查出现后刺激后存活的医院级变化。使用分层模型，我们将估计每家医院的反激活后生存率的风险调整率。我们将使用偏差方法确定具有异常良好生存率（高性能医院）的医院。这项工作将奠定我们为确定高性能医院的特定实践的基础，使他们能够取得卓越的成果。 AIM 3将涉及在GWTG反击中对参与医院的关键线人进行开发和实施，以获取有关医院特定的激发后护理惯例的详细信息。该调查将使我们能够确定高表现医院使用哪些特定策略，使他们能够实现出色的成果。我们假设这些策略将是多个方面的，包括特定的治疗方法，护理过程，人员以及组织因素（例如，领导力，交流）。确定最有效地改善后刺激后护理（“最佳实践”）的策略将告知设计质量改进干预措施，该干预旨在改善所有医院。这将是申请人未来R01的主题。