Optimal timing of prehospital advanced airway management and epinephrine administration for out-of-hospital cardiac arrest

院外心脏骤停院前高级气道管理和肾上腺素给药的最佳时机

基本信息

批准号：
10580352
负责人：
Masashi Okubo
金额：
$ 11.93万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-12-15 至 2024-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10580352
关键词：
Address Adult Affect American American Heart Association Applications Grants Canada Cardiopulmonary Resuscitation Caring Childhood Clinical Consensus Data Emergency medical service Epinephrine Event Future Goals Grant Guidelines Hospitals Individual International Intervention Intratracheal Intubation Knowledge Life Link Masks Medical Methodology Modeling Outcome Patient-Focused Outcomes Patients Play Population Pre-hospitalization care Principal Investigator Probability Public Health Recommendation Registries Research Resuscitation Risk Role Science Survival Analysis System Techniques Time Time Management United States cardiovascular emergency care systems cohort functional disability functional outcomes functional status improved outcome medication administration mortality out-of-hospital cardiac arrest pediatric patients secondary analysis stomach cardia survival outcome systematic review time use ventilation

项目摘要

ABSTRACT The overarching goal of this R21 Grant proposal is to identify the optimal timing of prehospital advance life support (ALS) interventions for patients with out-of-hospital cardiac arrest (OHCA). The ALS interventions include advanced airway management (AAM: i.e., endotracheal intubation and supraglottic airway placement) and epinephrine administration. OHCA is a major public health problem worldwide, annually affecting over 356,000 Americans with substantially high rates of mortality and functional disability. Emergency medical services (EMS) play an important role for patients with OHCA by providing initial prehospital care, including the ALS interventions in the field. However, the optimal timing of the ALS interventions remains unclear. The 2019 International Liaison Committee on Resuscitation (ILCOR) Summary Statement, International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations identified the optimal time of both AAM and epinephrine administration as key knowledge gaps. We recently found that, for adults with both shockable and nonshockable rhythms, benefit of epinephrine decreased as the administration was delayed, using the Resuscitation Outcomes Consortium (ROC) registry, a large multicenter OHCA registry in the United States and Canada. This R21 Grant project proposes to further expand our research into AAM and pediatric population, analyzing the ROC data. Specific research Aims include identifying the optimal timing of AAM (Aim 1A) and endotracheal intubation (Aim 1B) for adult patients with OHCA, the optimal timing of AAM (Aim 2A) and endotracheal intubation (Aim 2B) for pediatric patients with OHCA, and the optimal timing of epinephrine (Aim3) for pediatric patients with OHCA. This R21 Grant application will provide the Principal Investigator (PI) with protected time to achieve research aims to improve outcomes for patients with OHCA. The results of this R21 proposal will provide crucial information on the timing of ALS interventions for OHCA and inform future national and international resuscitation guidelines.

抽象的 R21 拨款提案的总体目标是确定院前预案生活的最佳时机对院外心脏骤停 (OHCA) 患者的支持 (ALS) 干预。 ALS 干预措施包括高级气道管理（AAM：即气管插管和声门上气道放置）和肾上腺素给药。 OHCA 是世界范围内的一个主要公共卫生问题，每年影响超过 356,000 名美国人的死亡率和功能残疾率极高。紧急医疗医疗服务 (EMS) 通过提供初始院前护理，包括在 OHCA 患者中发挥着重要作用 ALS 现场干预。然而，ALS 干预的最佳时机仍不清楚。 2019年国际复苏联络委员会 (ILCOR) 摘要声明，国际共识心肺复苏和紧急心血管护理科学与治疗建议将 AAM 和肾上腺素给药的最佳时间确定为关键知识差距。我们最近发现，对于具有可电击和不可电击节律的成年人来说，肾上腺素的益处使用复苏结果联盟 (ROC) 登记处，由于给药延迟而减少美国和加拿大的大型多中心 OHCA 登记处。该 R21 拨款项目建议进一步将我们的研究扩展到 AAM 和儿科人群，分析 ROC 数据。具体研究目的包括确定成人患者 AAM（目标 1A）和气管插管（目标 1B）的最佳时机对于 OHCA，儿科患者 AAM（目标 2A）和气管插管（目标 2B）的最佳时机 OHCA，以及 OHCA 儿科患者肾上腺素 (Aim3) 的最佳时机。这项 R21 补助金申请将为首席研究员（PI）提供受保护的时间来实现研究目标，以提高 OHCA 患者的结局。 R21 提案的结果将提供有关时间安排的重要信息 OHCA 的 ALS 干预措施，并为未来的国家和国际复苏指南提供信息。