Improving Appropriate Neurologic Prognostication after Cardiac Arrest. A Stepped Wedge Cluster Randomized Controlled Trial

Abstract

A multicenter quality intervention improved rates of appropriate neurologic prognostication after OHCA but did not increase survival with good neurologic outcome. Clinical trial registered with www.clinicaltrials.gov (NCT 01472458).

Factors associated with post-arrest withdrawal of life-sustaining therapy

“…Although this trial did not show significant improvement in survival, it does provide support for the feasibility of successful implementation of a standardized protocol. 16 …”

Improving Temporal Trends in Survival and Neurological Outcomes After Out-of-Hospital Cardiac Arrest

“…12 Additionally, the guideline recommendations were preceded by a local step-wedged randomized trial that evaluated a knowledge translation strategy to increase TTM among receiving hospitals starting in 2008. 17 During our study period, the use and successful implementation of TTM increased. After completion of the RCT in 2010, most receiving hospitals in our catchment area continued to participate in the Strategies for Post-Arrest Resuscitation Care (SPARC) network, where the goal was to standardize, monitor, and improve post-arrest care and encourage best practices.…”

“…Survival with good neurological outcome was collected after 2010, and defined as survival to hospital discharge with a Modified Rankin Score (MRS) ≤ 2. 17…”

Audit and Feedback in emergency: a systematic review and an Italian project to investigate and improve quality of care

“…All 24 studies followed the before/after scheme and 5 have a Plan-Do-Study-Act (PDSA) design. [8][9][10]22 While 9 studies involved different medical departments, 6,[10][11][12]17,19,21,22,27 15 of them concerned only Emergency departments and/or paramedics. Most of articles proposed a multimodal approach: only 7 of them concerned exclusively A&F. [7][8][9][10][11]13,22 As it's shown in Table 2, 9 articles talked about measurements for infective pathologies (especially antibiotic stewardship), 7,8,12,13,16,17,21,22,29 6 of them treated cardiac arrest or cardiovascular emergency problems, 8,19,20,[25][26][27] 2 of them treated stroke, 15,24 3 ones were about laboratory analyses 10,18,28 and 4 of them treated any other fields (diabetic ketoacidosis, use of a prothrombin complex, etc.…”