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Improving outcomes after pediatric cardiac arrest - the ICU-Resuscitation Project: study protocol for a randomized controlled trial.
Reeder, Ron W; Girling, Alan; Wolfe, Heather; Holubkov, Richard; Berg, Robert A; Naim, Maryam Y; Meert, Kathleen L; Tilford, Bradley; Carcillo, Joseph A; Hamilton, Melinda; Bochkoris, Matthew; Hall, Mark; Maa, Tensing; Yates, Andrew R; Sapru, Anil; Kelly, Robert; Federman, Myke; Michael Dean, J; McQuillen, Patrick S; Franzon, Deborah; Pollack, Murray M; Siems, Ashley; Diddle, John; Wessel, David L; Mourani, Peter M; Zebuhr, Carleen; Bishop, Robert; Friess, Stuart; Burns, Candice; Viteri, Shirley; Hehir, David A; Whitney Coleman, R; Jenkins, Tammara L; Notterman, Daniel A; Tamburro, Robert F; Sutton, Robert M.
Afiliación
  • Reeder RW; Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA. ron.reeder@hsc.utah.edu.
  • Girling A; The Learning Centre Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
  • Wolfe H; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Holubkov R; Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
  • Berg RA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Naim MY; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Meert KL; Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
  • Tilford B; Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
  • Carcillo JA; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Hamilton M; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Bochkoris M; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Hall M; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Maa T; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Yates AR; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Sapru A; Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA, USA.
  • Kelly R; Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA, USA.
  • Federman M; Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA, USA.
  • Michael Dean J; Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
  • McQuillen PS; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Franzon D; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Pollack MM; Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
  • Siems A; Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
  • Diddle J; Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
  • Wessel DL; Department of Pediatrics, Children's National Medical Center, Washington, DC, USA.
  • Mourani PM; Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, USA.
  • Zebuhr C; Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, USA.
  • Bishop R; Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, USA.
  • Friess S; Department of Pediatrics, Washington University Medical Center, St. Louis, MO, USA.
  • Burns C; Department of Pediatrics, Washington University Medical Center, St. Louis, MO, USA.
  • Viteri S; Department of Pediatrics, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.
  • Hehir DA; Department of Pediatrics, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.
  • Whitney Coleman R; Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
  • Jenkins TL; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
  • Notterman DA; Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA.
  • Tamburro RF; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
  • Sutton RM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Trials ; 19(1): 213, 2018 Apr 03.
Article en En | MEDLINE | ID: mdl-29615134
ABSTRACT

BACKGROUND:

Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology. METHODS/

DESIGN:

This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period.

DISCUSSION:

To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14%). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives. TRIAL REGISTRATION ClinicalTrials.gov, NCT02837497 . Registered on July 19, 2016.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Grupo de Atención al Paciente / Unidades de Cuidado Intensivo Pediátrico / Reanimación Cardiopulmonar / Mejoramiento de la Calidad / Paro Cardíaco / Capacitación en Servicio / Cuerpo Médico de Hospitales Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Qualitative_research / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: Trials Asunto de la revista: MEDICINA / TERAPEUTICA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos
Texto completo
Añadir a Mi BVS
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Grupo de Atención al Paciente / Unidades de Cuidado Intensivo Pediátrico / Reanimación Cardiopulmonar / Mejoramiento de la Calidad / Paro Cardíaco / Capacitación en Servicio / Cuerpo Médico de Hospitales Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Qualitative_research / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: Trials Asunto de la revista: MEDICINA / TERAPEUTICA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos