A webpage highlighting the research of Dr. Katie N. Dainty and her team
Final Report of the Cardiac Arrest PSP
BACKGROUND & RATIONALE:
Understanding how to build a longitudinal, coordinated and effective way to engage patients & families in Canadian resuscitation research and quality improvement will provide immense value to the overall health of the nation but requires an initial bold step. In order to build on the infrastructure we have put in place and create meaningful engagement opportunities for our public partners, we felt it is important to begin with the process of identifying priority areas from all perspectives, in particular examining where our priorities converge and diverge so that we can build a robust research agenda that speaks to everyone impacted by sudden cardiac arrest.
In 2018, Dr. Katie Dainty and a team of survivors and researchers were awarded a small grant from the Canadian Institutes of Health Research in order to conduct a JLA priority setting partnership exercise – this grant allowed us to create the Cardiac Arrest Priority Setting Partnership (CA-SPR). CA-SPR is a collaboration between people with lived experience of cardiac arrest and the healthcare providers who take care of them to build a robust agenda that speaks to everyone impacted by sudden cardiac arrest. See www.cardiacarrestresearchsurvey.ca for more information.
PURPOSE
Building on the public engagement infrastructure the Canadian Resuscitation Outcomes Consortium (CanROC) has put in place and to create meaningful engagement opportunities for our public partners, we have taken a bold step to engage our survivor & family member and health care professional community in identifying cardiac arrest priorities from all perspectives. In particular we are interested in examining where our priorities converge and diverge so that we can build a robust agenda that speaks to everyone impacted by sudden cardiac arrest.
METHODS
The JLA priority setting methodology (http://www.jla.nihr.ac.uk/jla-guidebook/) consists of four stages which each build toward the goal of coming to consensus on a “Top Ten” list of research priorities that reflect the needs of all stakeholder groups. Earlier this year, we created and distributed two online surveys (primary and interim) so people could first submit and then rank the questions about cardiac arrest that they think are most important. We received over 1500 responses from across Canada and the questions cover a range of topics related to treatment, outcomes, survivorship, the role of bystanders, and the impact of SCA on families.
Based on the ranked results from the interim survey, the top 20 uncertainties were taken forward for discussion and further prioritization to be held on November 14 2019. A group of selected representatives from all stakeholder groups have been invited to the workshop, including survivors, families, health care professionals (including Emergency Physicians, Cardiologists, nurses, rehabilitation specialists), EMS personnel and researchers. All participants were sent the short list of 20 uncertainties in advance of the workshop and asked to individually reflect on the research questions, to write down any comments and to rank these questions in order of priority.
RESULTS OF THE PSP
The full day PSP workshop successfully resulted in a group consensus on a Top 10 list of research priorities for out-of-hospital cardiac arrest in adults (Figure 1). There were several very lively conversations and debates throughout the day but in the end we feel that this list is very representative of all of the perspectives involved in cardiac arrest and most importantly actively involved survivors, family members and lay responders in the process.
The resulting Top 10 lists represents research priorities that span the full trajectory of cardiac arrest care including prehospital, in hospital and post-discharge timeframes. It also includes systems-, clinical- and patient-oriented questions which further confirms that all stakeholder perspectives are represented in the list.
Top 10 Research Priorities for Cardiac Arrest Research as ordered at the PSP Face to Face Workshop November 14 2019
- What are the most effective mechanisms for improving the rate of lay responder/bystander CPR?
- What interventions at the scene of a cardiac arrest (ie. longer time before transport, advanced life support crews, mechanical CPR, etc) improve resuscitation and survival outcomes?
- How do we improve response times and survival from SCA in rural areas in Canada?
- What resuscitation medications (ie. epinephrine, antiarrhythmics, bicarbonates, TXA, esmolol, etc) are the most effective in improving resuscitation and survival outcomes after cardiac arrest?
- What care do patient’s family members need during & after their loved one has an SCA?
- What should post-discharge care include for cardiac arrest survivors, what is the role of rehabilitation and how can recover be best supported post cardiac arrest?
- How can we communicate back to everyone involved in the resuscitation (ie. survivor, family, paramedics, ED staff, etc) after a cardiac arrest?
- What factors best predict neurologically intact survival following SCA in adults?
- Are their biomarkers or genetic tests that are effective for predicting SCA?
- What are the psycho-social impacts of survivorship on quality of life, both short and long-term and how are they addressed? (relationships, finances, functioning, employment, etc)
While the goal of the JLA methodology was to end up with a “Top 10” we will be incorporating the final Top 20 list into our knowledge translation activities as they also represent topics and areas of study that were important to all of the groups based on the survey responses from across Canada.
IMPACT & OUTCOME MEASUREMENT:
By actively engaging our public partners in the priority-setting process for resuscitation science in Canada we hope to see following impacts of our work:
- A prioritized agenda that helps ensure the most relevant research evidence gets created and moved into practice, enhancing the health care experience for patients and improving health outcomes for Canadians; in particular increasing the rate of survival from cardiac arrest and improving the experience of survivorship
- Economic benefits by prioritizing and optimizing the projects we develop for funding applications to be those supported by a co-designed agenda and attracting private investments in evaluative research that is important to patients and families;
- Rich perspectives on where we need innovation in patient-centred care such as areas like e-health, transitions in care and system level communication; and
- Collaboration among provinces and territories by providing jurisdictions with opportunities to learn from each other, and from patients and families across Canada, to the benefit of all Canadians