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CPR Coach Study
Less than half of children who suffer an in-hospital cardiac arrest (IHCA) will survive to hospital discharge. Effective chest compression depth, rate and minimal interruptions are essential to improve outcomes following IHCA. Devices placed on the chest that provide visual feedback during cardiopulmonary resuscitation (CPR) can improve chest compression quality, but there is substantial room for improvement. Strategies are needed to help teams translate visual CPR feedback into optimized CPR delivery.
Hunt et al are developing the CPR Coach “at the Bench”, i.e. in the simulation lab after recognizing Resuscitation Leaders cannot simultaneously manage high quality basic life support (BLS), pediatric advanced life support (PALS), diagnose and treat reversible causes and do all well. A CPR Coach will provide real time feedback to compressors to optimize compliance with American Heart Association (AHA) CPR guidelines and cognitively unload the Resuscitation Leader, enabling them to focus on the PALS algorithm and reversible causes. Hunt's previous research reports a significant increase in “excellent epochs” of CPR (22% to 45%; p<0.001) after integrating the CPR Coach into resuscitation teams using CPR feedback defibrillators as part of a resuscitation quality bundle at a single site. Cheng et al recently leveraged the INSPIRE network to conduct a multicenter, randomized controlled trial of simulated cardiac arrests, with significant improvement in excellent CPR for teams with a CPR Coach versus those without. The next step in translation from Bench to Bedside is assessment of scalability and generalizability, i.e. to roll out the simulation-based CPR Coach role curriculum at a clinical unit level across the PediRES-Q international resuscitation network, enrolling 14 sites with existing Data Use Agreements.
Goals and Aims
Our specific aims are to:
1) develop a simulation-based “CPR Coach Roll-out” curriculum for clinical units that employs the Rapid Cycle Deliberate Practice (RCDP) approach and on-line endurable educational materials,
2) perform a stepped wedge, cluster randomized trial across the PediRES-Q Network to assess whether implementation of the CPR Coach Roll-out is associated with increased compliance with AHA CPR guidelines for pediatric IHCA at the unit level,
3) perform exploratory analyses to enable design of future studies regarding the relationship between the CPR Coach Roll-out and the a) Resuscitation Leader’s perceived workload and b) survival to discharge.
The long-term objective of this project is to increase neurologically intact survival from IHCA for children. If successful, introducing the CPR Coach Roll-out curriculum will be associated with increased compliance with AHA CPR guidelines on a multi-center level and enable design of larger studies to evaluate the impact on survival. This project directly aligns with the INSPIRE mission to improve delivery of medical care (high quality CPR) to acute ill children (in cardiac arrest) and ultimately improve survival (our exploratory aim) in the pediatric population.
Sites and Enrollment
We are currently no longer accepting sites for enrollment Our current sites include:
- Akron Children's Hospital
- Boston Children's Hospital
- Children's Healthcare of Atlanta
- Cincinnati Children's Hospital Medical Center
- Children's Hospital of Orange County
- Children's Hospital of Philadelphia
- Cohen Children's Medical Center
- Johns Hopkins All Children's Hospital
- Nationwide Children's Hospital
- Riley Hospital of Children
- Seattle Children's Hospital
- Sick Kids of Toronto
- Stanford Children's Health
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