PROJECT SUMMARY / ABSTRACT Out-of-hospital cardiac arrest (OHCA) is the most common cause of death from cardiac disease in adults in the United States. Among patients who are resuscitated and survive to hospital admission, survival to hospital discharge ranges from 14% to 42%. Treatment at ST segment elevation myocardial infarction (STEMI) centers, defined as hospitals that are capable of performing percutaneous coronary intervention at all times, is associated with both overall survival and survival with good neurologic recovery compared with treatment at non-STEMI centers. However, even among STEMI centers, rates of survival with good neurologic recovery ranged from 39% to 67% after adjusting for usual patient and hospital characteristics. These observations suggest that there are unknown features of hospitals and care delivery that affect the impact of therapeutic interventions that are known to be beneficial. Differences in clinical care and organizational culture (e.g., teamwork, communication) may explain variation in outcomes within STEMI centers that are all capable of delivering the same interventions. This mentored career development award combines research and training activities designed to help the PI achieve her career goal of becoming an independent investigator who uses both quantitative and qualitative methods to improve outcomes for patients with cardiovascular emergencies. The overarching goal of this K08 proposal is to develop a set of “best practices” related to acute cardiovascular interventions that are associated with survival with good neurologic recovery following OCHA. The primary research objective is to identify the factors in clinical care and organizational culture, particularly those related to acute cardiovascular interventions, that are associated with survival with good neurologic recovery for patients resuscitated from OHCA. Specific research aims include 1) to qualitatively compare clinical care and organizational culture at STEMI centers with the highest and lowest adjusted performance in survival with good neurologic recovery in OHCA and 2) to quantify the association between factors in clinical care and organizational culture related to cardiac catheterization and hemodynamic support—two specialized cardiac interventions provided by STEMI centers—and survival with good neurologic recovery among patients resuscitated from OHCA. These research activities will be combined with formal training in qualitative research methods, analysis of clustered data, and implementation science. This K08 proposal will result in an intervention to improve outcomes for patients resuscitated from OHCA that can be tested in a subsequent proposal. Additionally, the PI will have gained the research skills and experience necessary to become an independent investigator focused on improving outcomes for patients with cardiovascular emergencies.

PROJECT NARRATIVE This proposal is relevant to public health because it will result in a set of “best practices” that can be implemented at hospitals nationwide to improve outcomes from out-of-hospital cardiac arrest, the most common cause of death from heart disease in the United States. This proposal addresses the NIH's mission to “lengthen life and reduce illness and disability” by identifying factors in clinical care and organizational culture that are associated with good outcomes in patients who have suffered out-of-hospital cardiac arrest.