Clinical Research Directory

Critical Care Admission Following Emergency Department's Resuscitation Room Care

This prospective multicenter observational study aims to describe resuscitation room activity in France and to compare critical care admission within 24 hours between patients directly admitted to the resuscitation room and those admitted secondarily after initial emergency department management. Adult patients admitted to the resuscitation room over a 72-hour period in participating centers will be included. Data collection includes patient characteristics, triage severity, physiological parameters, critical interventions, and outcomes at 24 hours.

A Study on the Impact of a New Canton-Wide First Responder System in Zug, Switzerland, on Survival After Adult Cardiac Arrest-Examining Early Life-Saving Organized Help, Fast Defibrillation, and Improved Outcomes for Out of Hospital Cardiac Arrest

REVIVE Zug: Improving Emergency Response for Out-of-Hospital Cardiac Arrest Out-of-hospital cardiac arrest (OHCA) represents one of the most time-critical medical emergencies, where rapid recognition and immediate intervention are decisive for survival and neurological outcome. Early activation of emergency services, prompt initiation of cardiopulmonary resuscitation, and rapid defibrillation using automated external defibrillators (AEDs) are key components of the chain of survival. In many regions, organized First Responder systems-such as fire services, police forces, and trained lay responders supported by dispatcher-assisted instructions-arrive at the scene before emergency medical services (EMS) and initiate life-saving measures. Evidence from multiple EMS systems indicates that the early involvement of First Responders is associated with higher rates of return of spontaneous circulation (ROSC) and improved survival to hospital discharge with favorable neurological outcomes. Regions with well-established First Responder networks consistently report better OHCA outcomes compared with regions without such systems. In the canton of Zug, a comprehensive First Responder system has recently been implemented alongside an established hybrid EMS response model. In this system, resuscitation efforts are led either by an Emergency Physician (EP) or by a highly trained Critical Care Paramedic (CCP), depending on operational availability. Both roles operate within clearly defined competencies and provide the full scope of advanced prehospital care. This hybrid leadership model offers a unique opportunity to examine whether the professional background of the team leader influences resuscitation outcomes in real-world clinical practice. The REVIVE Zug study aims to evaluate the impact of the canton-wide First Responder system on outcomes following OHCA. Key outcomes of interest include ROSC rates, hospital admission after cardiac arrest, the occurrence of shockable rhythms at EMS arrival, and outcomes achieved before EMS arrival. In addition, the study explores whether team leadership by an EP or a CCP is associated with differences in resuscitation outcomes. Further analyses focus on time intervals within the chain of survival, such as time from cardiac arrest to arrival of organized help and time to first defibrillation, as well as on event timing and basic demographic characteristics. The study is based on anonymized data from established EMS quality registries and the national Swiss Reca database. By comparing OHCA cases before and after implementation of the comprehensive First Responder system, the project seeks to provide robust, practice-oriented evidence to inform future development of prehospital emergency care systems in Switzerland and comparable settings.

The Association Between Post-resuscitation Time Series Management in the Emergency Department and Short-term Outcomes for Out-of-hospital Cardiac Arrest Patients

This study examines the impact of emergency department (ED) management on short-term outcomes of nontraumatic adult out-of-hospital cardiac arrest (OHCA) patients. Conducted by a research team at National Taiwan University Hospital and its affiliated hospitals, including branches in Hsinchu and Yunlin, the study spans from January 2016 to August 2023. It focuses on a sequential population of patients, analyzing data like age, gender, medical history, prehospital care details (e.g., witnessed collapse, bystander CPR), and specifics of ED management. OHCA, with an incidence rate of 50-100 per 100,000 people, presents high mortality and severe complications, leading to significant healthcare expenditures. After resuscitation in the ED, only about one-fifth of patients achieve return of spontaneous circulation (ROSC). The prognosis for these patients remains grim, with a mere 5% experiencing favorable neurological outcomes. Understanding the mechanisms of OHCA, identifying risk factors, effective interventions, and the timing of ED treatments like vasopressors and electrocardiography are crucial. Patients post-OHCA often undergo a postcardiac arrest syndrome (PCAS), marked by cellular hypoxia and a consequential inflammatory response. Stability of vital signs and rapid ED interventions, including identifying OHCA causes and coordinating with specialists, are vital for short-term recovery. This study aims to determine if ED management and time-related factors from ROSC to various interventions (e.g., ECG, CT scans) affect short-term survival rates, including survival to hospital admission and survival after 1, 3, and 7 days. By retrospectively analyzing patient data, including Utstein Style prehospital cardiac arrest registry variables and emergency department management details, the study seeks to shed light on the crucial phase of post-resuscitation care. The ultimate goal is to improve survival rates and neurological outcomes in OHCA patients, emphasizing the need for more comprehensive research in this area

Impact of a mHealth Supportive Tool on Cardiopulmonary Resuscitation' Situational Awareness

This study will be a prospective, single-center, randomized controlled trial in a tertiary pediatric emergency department with two parallel groups of voluntary pediatric physicians and nurses. The impact of a mHealth supportive tool will be compared with conventional communication methods on situational awareness, leadership, team communication effectiveness and performance during standardized, simulation-based, pediatric in-hospital cardiac arrest scenario using a high-fidelity manikin. Thirty-six participants will be randomized (1:1). The primary endpoint is the situational awareness score measured with the situation awareness global assessment technique (SAGAT) instrument.

Interactive Resuscitation Application for Mothers About to Experience Premature Infant Resuscitation

The purpose of this study is to design, develop, validate and pilot test an interactive Maternal Resuscitation Navigation Application (MARINA) for the purpose of providing information and guidance about the expected events that a premature infant will experience during initial resuscitation upon delivery. This information will be shared via computer app prior to the time that the mother would be in distress due to active labor. The application will be pilot tested for functionality, usability and feasibility of future use and research in clinical settings. Focused aspects of the application will include simulated video of the active delivery environment, explanation of each team member's role in resuscitation and specific activities involved in premature infant resuscitation. To assure the application addresses key information mothers would desire, the application will include content developed with input from a consulting group of mothers who have experienced premature infant resuscitation in the delivery room. Additionally, prior research by the research team will inform the build of this application. The application will have the ability for mothers to choose whether to view close up procedures (bag/mask positive pressure oxygen delivery, intubation, line placement, etc.). She may alternatively select to only view the broader view of the room while listening to the description of activities occurring at that time. The mother will be able to choose her level of interactivity depending on her comfort level. The application will go through multiple levels of testing throughout the development process. After an iterative process, when the research team finds the application acceptable, a small group of consulting parents and experienced clinicians will review the application for functionality (ease of use) and content validity. Aim 2: To pilot test the functionality, usability and feasibility of the interactive Maternal Resuscitation Navigation Application (MARINA) for future use and research in clinical settings to reduce maternal distress associated with premature infant resuscitation.

A Clinical Trial to Study the Feasibility and Acceptability of an App to Support Pediatric Resuscitation

The goal of this clinicial trial is to test the acceptability and feasibility of linear cognitive aid intervention to support EMS teams in responding to pediatric emergencies. We are testing the hypothesis that cognitive aids with linear logic will be feasible to use and acceptable to EMS teams in urban and rural areas. Researchers will compare technical performance, teamwork, and self-assessed cognitive load of participants to see the difference between performing resuscitations using their current standard with existing cognitive aids and using our linear cognitive aid. Participants' teams will: * perform in situ high-fidelity simulation of two critical children's resuscitation scenarios * be randomized to 1) perform both resuscitations with their current standard with existing cognitive aids or 2) perform both resuscitations using our linear cognitive aid.

Effects of Delayed Cord Clamping During Resuscitation of Newborn Near Term and Term Infants

This study evaluates resuscitation with an intact umbilical cord compared to resuscitation with the umbilical cord cut. Half of the newborn babies in need of resuscitation will be handled while having an intact umbilical cord and half will have their umbilical cord cut.

Delivery Room Intervention and Evaluation Network

The American Academy of Pediatrics (AAP) convened the multi-center Delivery Room Intervention and Evaluation (DRIVE) Network to establish essential infrastructure to collect, coordinate, and analyze core demographic, resuscitative, and outcome data for an inclusive and diverse population of infants who receive delivery room resuscitation at participating centers. The DRIVE Network consists of delivery hospitals across the United States, covering a range of geographic, urban/rural, racial/ethnic diversity across the country. Together, DRIVE seeks to compare practice-level delivery system characteristics, identify best practices, evaluate outcomes from various interventions, and promote professional development through dissemination via the wide reach of the Neonatal Resuscitation Program.

Venous Excess Ultrasound for Personalized Resuscitation in Septic Shock

The goal of this pilot clinical trial is to determine if conducting a larger study using venous excess ultrasound (VEXUS) to guide fluid management in patients with septic shock is feasible. Septic shock is a life-threatening condition where infection causes dangerously low blood pressure. While fluids are essential for treatment, too much fluid can harm the kidneys and result in the need for dialysis. The main questions it aims to answer are: 1. Is it feasible to recruit patients, obtain consent, and follow the VEXUS-guided management protocol? 2. Does VEXUS-guided management, compared with usual care, improve the health and well-being of patients with septic shock? Researchers will compare two groups: one receiving VEXUS-guided fluid management versus another receiving standard care, to assess the feasibility of a larger trial and explore whether VEXUS prevents fluid overload and kidney problems. Participants in the VEXUS group will: 1. Undergo VEXUS scans every 24 hours for 3 days 2. Receive fluid management guided by VEXUS findings (including fluid restriction or removal if we identify venous congestion) and undergo cardiac ultrasound if we identify moderate to severe congestion 3. Be monitored for 28 days to track kidney function, need for dialysis, and survival.

Mobile Virtual Simulation Training in Essential Newborn Care for Healthcare Workers in Low and Middle Income Countries

Intrapartum asphyxia and prematurity are the leading causes of neonatal mortality in low and middle income countries. Neonatal resuscitation training reduces asphyxia-related newborn mortality and morbidity, but in the absence of continuing low-dose, high frequency practice, these initial gains rapidly decay. The investigators propose to develop and evaluate innovative mobile virtual simulations for refresher training on neonatal resuscitation and essential newborn care to support the retention of knowledge and skills among health care workers in low and middle income countries.