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

使用非侵入性波形分析 (CPR-NOVA) 验证生理心肺复苏质量

• 批准号: 9910446
• 负责人: ROBERT ALLEN BERG
• 金额: $ 40.47万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9910446
• 关键词: Affect; Algorithms; Ancillary Study; Area; Arterial Lines; Blood Pressure; Brain Injuries; Carbon Dioxide; Cardiopulmonary Resuscitation; Cardiovascular system; Caring; Chest; Child; Childhood; Clinical; Collection; Critical Care; Data; Databases; Defibrillators; Devices; Diastolic blood pressure; Disease; Event; Failure; Feedback; Funding; Future; Gold; Guidelines; Heart; Heart Arrest; Hospitals; Infrastructure; Intensive Care Units; Investigation; Life; Link; Lung; Machine Learning; Mechanics; Medical; Methods; Monitor; Morbidity - disease rate; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Development; Neurologic; Neurological outcome; Organ; Outcome; Parents; Patient Care; Patient Monitoring; Patients; Performance; Perfusion; Photoplethysmography; Physiologic Monitoring; Physiologic pulse; Physiological; Procedures; Process; Provider; Public Health; Pulse Oximetry; ROC Curve; Research; Resuscitation; Risk Factors; Signal Transduction; Survival Rate; Survivors; System; Techniques; Technology; Time; Validation; Vulnerable Populations; Work; classification algorithm; clinical care; clinically relevant; hemodynamics; improved; improved outcome; machine learning algorithm; machine learning method; modifiable risk; monitoring device; multimodality; novel; patient response; pediatric patients; prospective; response; survival outcome; ventilation

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. !

项目摘要 小儿心脏骤停每年影响成千上万的儿童。进步的心脏和肺衰竭是 在许多事件中，诱人的原因。尽管过去两个人的生存结果有所改善 几十年来，这些孩子中有一半以上仍然无法生存。随着新的脑损伤使护理复杂 幸存者，这些儿童的伯恩（Burnen）和公众的健康状况很大。 心肺复苏（CPR） - 提供胸部压缩和的医疗程序 心脏骤停期间的通风 - 挽救生命，更高质量的心肺复苏术更有效地这样做。一 提高CPR质量的方法是使用CPR质量监测除颤器。通过提供现实 CPR力学目标（例如胸部压缩深度和速率）的时间反馈，它们代表了最佳 目前可用于提高CPR性能的患者护理选项。不幸的是，这些设备中的大多数是 对于许多儿科患者而言，未批准儿童或使用太大的垫子。那，当前 技术将有意义的CPR质量监测的好处限制为一小部分儿童 遭受心脏骤停。鉴于小儿CPR质量与结果之间的牢固关联，新方法 迫切需要监测CPR质量以改善对这一脆弱人群的护理。 生理指导的CPR是一种有前途的技术，它使用患者的血液动力学反应 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 通过使用患者监视器的数据，质量监测技术。不幸的是，因为许多患者确实 在逮捕时没有动脉内线以指导CPR，其临床影响受到限制。到 克服这一限制，此辅助应用的目的是利用现有的基础设施 美国国家儿童健康与人类发展资助的协作小儿重症监护 研究网络（CPCCRN）和国家心脏的独特血液动力学波形数据库，肺， 和血液研究所资助的父母R01 - ICU震荡（ICU-Resus）项目 - 验证两个 几乎每个小儿心脏骤停的非侵入性生理CPR监测器：1）末端潮汐碳 二氧化物（ETCO2）; 2）通过脉搏血氧饱和度获得的光杀菌学（PPG）。使用精致 机器学习方法，提出了一种前瞻性观察分析投资 目的：1）在接受至少1分钟的儿童中评估ETCO2作为无创CPR质量监测仪 CPCCRN重症监护室中的心肺复苏术； 2）使用新颖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CPR质量监测器。 通过利用CPCCRN的大量基础架构，新型的血液动力学波形数据库 ICU-Resus和高级机器学习分析，此提交代表了一个独特的机会 验证两个非侵入性生理性儿科CPR质量监测器，以改善临床护理并挽救生命。