The Strategies for Post Arrest Resuscitation and Care Network

NCT00683683 | Completed DMC

• 1 other identifier: SPARC (Morrison 038-2008)
• Study Type: interventional
• Target: 32
• Locations: 0 countries
• Sites: N/A

Brief Summary

Background: One of the 2010 Impact Goals of the Emergency Cardiac Care (ECC) Committee of the American Heart Association is to double survival from cardiac arrest. Currently, approximately 60% of adults and 50% of paediatric patients that regain spontaneous circulation following cardiac arrest die before leaving the hospital. A key piece of the "chain of survival" is this fifth link; the care of patients post-arrest. Although there are several modalities recommended for post arrest care, therapeutic hypothermia is the only in-hospital therapy that has been demonstrated in randomized clinical trials to improve patient outcome after cardiac arrest. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that hypothermia is delivered inconsistently, incompletely, and with undue delay in hospitals receiving resuscitated patients; only 26% of physicians and 26% of hospitals regularly institute a hypothermia protocol. Primary Objective: To design and apply a knowledge translation program for the 2005 AHA guideline on hypothermia post cardiac arrest and enable effective implementation of hypothermia in 100% of eligible OHCA patients. The integration of two robust data collection systems, which include both pre-hospital and in-hospital indicators, will give complete process of care and clinical outcome information for all cardiac arrest patients. Primary Endpoint: the proportion of eligible out of hospital cardiac arrest patients cooled to 32-34°C within 6 hours of ED arrival. Study Design: This project will be implemented through an established research collaborative of 43 hospitals in southern Ontario currently participating in the Toronto site of the Resuscitation Outcomes Consortium. A stepped wedge study design will be employed, whereby the intervention will be rolled-out sequentially to the participating hospitals over a number of time periods as sites reach pre-defined benchmarks. The multifaceted KT strategy will include 1) local multidisciplinary champions in ED, ICU, and Cardiology 2) A simple protocol for application of hypothermia, tailored to local needs and policy; 3) Identification of perceived and actual barriers to knowledge use; 4) Development of an implementation tool kit and 5) Providing timely feedback on benchmarks for hypothermia and outcomes

Conditions

Cardiac Arrest

Keywords

cardiac arrest, hypothermia, knowledge translation

Outcome Measures

Primary Outcomes (1)

• The proportion of eligible out of hospital cardiac arrest patients cooled to 32-34°C within 6 hours of ED arrival.

  Within 6 hours of ED arrival.

Study Arms (1)

Cooling

OTHER

Cardiac arrest patients will be cooled to 32-34°C within 6 hours of ED arrival

Behavioral: Knowledge Translation

Interventions

Knowledge Translation BEHAVIORAL

The multifaceted KT strategy will include 1) local multidisciplinary champions in ED, ICU, and Cardiology 2) A simple protocol for application of hypothermia, tailored to local needs and policy; 3) Identification of perceived and actual barriers to knowledge use; 4) Development of an implementation tool kit and 5) Providing timely feedback on benchmarks for hypothermia and outcomes.

Also known as: Clinical Protocol;, Reminders;, Audit & Feedback;, Network

Cooling

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Hospitals participating in the ROC network

You may not qualify if:

• Hospitals who do not receive out-of-hospital cardiac arrest patients

Sponsors & Collaborators

• Unity Health Toronto: lead
• Heart and Stroke Foundation of Canada: collaborator
• Laerdal Medical: collaborator

Related Publications (2)

• Morrison LJ, Brooks SC, Dainty KN, Dorian P, Needham DM, Ferguson ND, Rubenfeld GD, Slutsky AS, Wax RS, Zwarenstein M, Thorpe K, Zhan C, Scales DC; Strategies for Post-Arrest Care Network. Improving use of targeted temperature management after out-of-hospital cardiac arrest: a stepped wedge cluster randomized controlled trial. Crit Care Med. 2015 May;43(5):954-64. doi: 10.1097/CCM.0000000000000864.

  PMID: 25654175 DERIVED

• Dainty KN, Scales DC, Brooks SC, Needham DM, Dorian P, Ferguson N, Rubenfeld G, Wax R, Zwarenstein M, Thorpe K, Morrison LJ. A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial. Implement Sci. 2011 Jan 14;6:4. doi: 10.1186/1748-5908-6-4.

  PMID: 21235799 DERIVED

MeSH Terms

Conditions

Heart Arrest; Hypothermia

Interventions

Clinical Protocols

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases; Body Temperature Changes; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Therapeutics; Epidemiologic Study Characteristics; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation

Study Officials

• Laurie Morrison, MD, MSc

  Sunnybrook Health Sciences Centre

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director, Rescu

Study Record Dates

• First Submitted: May 15, 2008
• First Posted: May 23, 2008
• Study Start: April 1, 2008
• Primary Completion: December 1, 2010
• Study Completion: December 1, 2010
• Last Updated: May 27, 2015

Record last verified: 2014-05