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

基本信息

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
项目类别：
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

项目摘要

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）：院内心脏骤停是一种常见且致命的问题，在美国每年造成约 160,000 人死亡。以前改善心脏骤停结果的努力主要集中在逮捕前（例如快速反应小组）和逮捕期间因素（例如心肺复苏 [CPR] 的质量）；对逮捕后因素或复苏后护理的重视要少得多。然而，近 50% 的心脏骤停死亡发生在复苏后阶段，人们普遍认为存活率可以大幅提高。美国心脏协会等专业协会最近认识到复苏后阶段的重要性。然而，我们对可能改善患者预后的复苏后护理关键要素的理解仍然非常有限。我们并不确切了解哪些疗法、方案和组织因素是有效的。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，Saket Girotra 博士是一位非常有前途的心脏病专家，对健康服务研究感兴趣并接受过培训。目标 1 将涉及对现有文献的系统回顾，以全面综合已研究的用于改善复苏后阶段生存的所有干预措施（治疗、护理过程、组织干预措施）。将使用定性和定量（例如荟萃分析）方法系统地综合现有证据。目标 2 将使用 Get With TheGuidelines-Resusitation (GWTG-Resusitation) 登记处的数据来检查医院层面的复苏后生存率差异。使用分层模型，我们将估计每家医院的风险调整后复苏后生存率。我们将使用偏差方法来确定存活率特别好的医院（高绩效医院）。这项工作将为我们确定高绩效医院的具体做法奠定基础，使他们能够取得卓越的成果。目标 3 将涉及对参与 GWTG-Resusitation 的医院的关键信息提供者进行调查，以获得有关医院特定复苏后护理实践的详细信息。这项调查将使我们能够确定高绩效医院采用哪些具体策略来实现卓越的成果。我们假设这些策略将是多方面的，包括具体的治疗、护理过程、人员以及组织因素（例如领导力、沟通）。确定改善复苏后护理最有效的策略（“最佳实践”）将为设计质量改进干预措施提供信息，以改善所有医院的复苏后护理。这将是申请人未来 R01 的主题。