Admission/Discharge Form:
1. System Entry Time
2. Age
3. Born this Admission
4. Gender
5. Race
6. Hispanic Ethnicity
7. Weight
8. Residence Prior to System Entry
9. Admission Adult and Pediatric Cerebral Performance Category
10. Newborn/Neonate Specific Data
(a) Prenatal Care Received
(b) Maternal Conditions
(c) Delivery Details
(i) Fetal Monitoring
(ii) Delivery Mode
(iii) Presentation
(iv) Apgar Scores
(v) Cord pH
(vi) Gestational Age
(d) Special Circumstances Recognized at Birth
11. Discharge Data
(a) Discharge Disposition
(b) Date/Time of Discharge/Death
(c) Do Not Attempt Resuscitation Order During this Admission (Date/Time)
(d) Life Support Withdrawn
(e) Organs Recovered
(f) Discharge Destination
(g) Adult and Pediatric Cerebral Performance Category at Discharge
Cardiopulmonary Arrest Form:
1. Date/Time Need for Chest Compression and/or Defibrillation Recognized
2. Pre-event Data (Optional data element)
(a) Patient Status Prior to Event
(b) Pre-event Vital Signs
3. Pre-Existing Conditions
4. Interventions Already in Place at Time of Event
5. Event data
6. Initial Condition Data
7. Defibrillation Data
8. Types of Ventilation/Airways Used
9. Epinephrine/Vasopressin Bolus Data
10. Other Drug Interventions
11. Non-drug Interventions
12. Event Outcome data
13. Post Return of Circulation Data
(a) Induced Hypothermia (yes/no)
(b) Highest Temperature in First 24 h.
14. CPR Quality
(a) End Title CO2 Data
(b) Arterial Line Data
(c) Quality of Compression Data
15. Resuscitation Related Events and Issues
Acute Respiratory Compromise Event Form:
1. Date/Time Need for Emergency Assisted Ventilation Recognized
2. Pre-Event Data
3. Pre-Existing Conditions (Optional data element)
4. Interventions Already in Place at Time of Event
5. Event data
6. Immediate Cause Data
7. Ventilation Data
8. Other Interventions
9. Event Outcome data
10. Resuscitation Related Events and Issues
Medical Emergency Team Event Form:
1. Date/Time of Team Activation
2. Pre-Event Data
(a) Patient Status Prior to Event
(b) Pre-Event Vital Signs
3. Event data
(a) Team Arrival and Departure Date/Time
(b) Subject type and Illness Category
(c) Event Location
(d) Vital Signs at the Time of Event
4. Team Activation Triggers
5. Drug Interventions
6. Non Drug Interventions (diagnostic and therapeutic)
7. Event Outcome
(a) Reason Event Ended
(b) Transfer Location
8. Review of MET Response
(a) Response Delays
(b) Equipment or Medication Delays
(c) Communication Issues
Multiple benefits exist for using the database, including continuous process improvement opportunities and benchmarking with hospitals according to size, region, type of hospital (e.g., children’s hospital), and type of patient (e.g., surgical cardiac patients, medical cardiac patients, etc.). National and local awards and recognition are possible for hospital teams that demonstrate continued compliance with pre-defined metrics. The program also offers various professional education opportunities to improve resuscitation quality of care including web-based conferences and monthly newsletters.
Perhaps as important as the data generated for local quality improvement and benchmarking, is the wealth of published research from the registry. Participating hospitals are able to apply to GWTG-R for access to the de-identified dataset to answer specific research questions. Strict standards and requirements exist for data requests from the registry and all requests are reviewed by the GWTG- R Committee. Each project is reviewed for feasibility, validity and novelty and performed in an expeditious manner; publications are expected to occur within a year of attaining data. More than 50 pediatric and adult resuscitation science papers have been generated based on data gathered from the GWTG-R Registry, and a multitude of studies are currently in the review process. A list of all studies published and all current research requests are available on the American Heart Association website.
Literature Review
We will briefly review a few important pediatric and adult GWGT-R investigations. Notably, recent GWTG-R publications have established that outcomes of in-hospital cardiac arrest have improved over the last decade in GWTG-R hospitals; patients with prolonged CPR can survive with favorable neurological outcomes; and resuscitation process failures are associated with worse outcomes. In addition, a GWTG-R study has raised questions about the optimal pediatric defibrillation dose.
Girotra et al. established that outcomes following in-hospital pediatric cardiac arrest have improved in GWTG-R hospitals from 2000 to 2009. The rate of survival to discharge increased (risk adjusted rates: 14.3 % in 2000 to 43.4 % in 2009; adjusted Risk Ratio per year 1.08; 95 % CI 1.01–1.16; p for trend = 0.02). The improved outcome was primarily driven by an increase in the rate of return of spontaneous circulation from 42.9 % in 2000 to 81.2 % in 2009. In a similar adult study Girotra showed that despite an increase in cardiac arrests due to PEA or asystole, the risk-adjusted rates of survival to discharge after adult in-hospital cardiac arrest increased 13.7–22.3 % from 2000 to 2009 [17].
One of the biggest decisions clinicians face when initiating CPR is when to stop resuscitative efforts. Limited evidence is available to guide these difficult decisions. In contrast to widely held beliefs that pediatric resuscitation is futile after 30 min [14], Matos et al. established that 12 % of children survived to hospital discharge after >35 min of CPR in a GWTG-R study of 3,400 pediatric in-hospital cardiac arrests over a 10-year period [4]. Importantly, 60 % of these survivors of prolonged CPR had favorable neurological outcomes. As in previous published data from the GWTG-R, pediatric surgical cardiac patients had superior survival rates when compared to all other categories [6]. Goldberger et al. found similar trend in survival from prolonged cardiac arrest duration in adults. In another GWTG-R study of 64,339 adult cardiac arrest patients at 435 US hospitals, Goldberger et al. also demonstrated that prolonged CPR can result in successful resuscitation among adults: 12 % of all adults who attained ROSC did so after >30 min of CPR, nearly 10 % of adults with CPR >25 min survived to hospital discharge and 78 % of these patients who survived after >30 min of CPR had favorable neurological outcomes [18]. Of course, both the pediatric study and adult study showed that survival rates were lower after prolonged CPR compared with shorter duration CPR. These GWTG-R studies have been instrumental in increasing our understanding regarding the relationship of CPR duration to outcome.
CPR duration was overall inversely associated with survival to discharge with favorable neurologic outcomes [4]. This multi-center study captured over 3,400 pediatric in hospital arrests over a 10-year period, and data collected allowed for stratification of patients by illness category. This study reinforced the previously published data from the GWTG-R by Ortmann et al. that, surgical cardiac patients had improved survival outcomes when compared to all other categories [18].
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