INTCAR 2.

0: Introductions
and

Why Bother With a Cardiac Arrest Registry?

Disclosures

 Thank you for coming! Please introduce yourselves

 Barb Unger
Appreciation for arranging all details of meeting Appreciation for arranging funding through MHIF Volunteer efforts & passionate involvement

Administrator for Data Quality and Site Enrollment

INTCAR
Data collection is a pain in the neck
Consumes time Threatens patient confidentiality Costs money Frustrating Thankless so why bother?

INTCAR
Grassroots registry of centers interested in the quality & details of post-resuscitation care
Therapeutic hypothermia ICU care Cardiac support Prognostication

Because the users are dealing with cardiac arrest survivors on a daily basis, were uniquely well acquainted with the clinical problems involved

INTCAR
Organizes and standardizes the data collection process
Individual centers are more thorough Individual centers can compare themselves to the groups norm The group develops a BIG and consistent data set
Defines a standard of care Describes problems and opportunities Creates preliminary data for further investigations

INTCAR
Creates a community of clinicians with the same problems and same questions Allows us to see more clearly what we are doing, and does not allow us to hide from problems we would prefer to ignore

Therapeutic Hypothermia
Did not invent post-resuscitation care, but revived it
Showed we could do better Forced us to reinvent the standard of care Showed us that we have a lot of further work to do!

INTCAR AT A CROSSROADS
Our investigators are busy clinicians
We have a lot of data, more than we have had time to evaluate The questions are becoming more specific than we can answer in the registry Individual centers are difficult to recruit, because the data set is too large Our chief is becoming famous & too busy to attend to all of the issues that require attention

Dissolve, or evolve

London, 2011
Champions League final Red Barn Indian Restaurant Barcelona demolishes Manchester United, but
London does not burn!

INTCAR decides to evolve

 History & Preliminary findings

INTCAR 1
Problems with current registry model
Many important observations with current data set, but Current questions do not allow for more detailed evaluation of certain phenomena
EEG Prognostication Neuroimaging Cardiac cath Hemodynamics Biochemical & Metabolic

With 158 data points, already overwhelming

INTCAR 2.0
Improve quality of data uploads
Complete set (for research) Limited set
Standardized QA/QI report
Time to onset cooling AEs Adjusted outcomes data (for rhythm) Quality of data entry!

INTCAR 2.0
Decrease basic core data set Add satellite surveys with greater level of detail
Fewer participants in each, but greater detail Core data set continues to grow Satellite surveys create niches of expertise, and the participants in a survey become an independent research collaboration

Imaging Survey ~60Q

Prognostication Survey ~110Q

Cardiology Survey ~80Q

Basic INTCAR data set ~50 points Hemodynamics Survey ~75Q Seizures and EEG Survey ~80Q

Methods/ Complications Survey ~90Q

Cooling Survey
Focus on methods of cooling, adverse events, shivering Endovascular vs surface, intranasal, other Measurement and control of shivering Duration & depth of cooling Pneumonia, bleeding, electrolytes

EEG & Neuroimaging Survey

MRI
Quantitative assessment of injury Patterns of brain injury re: no flow & low flow Correlation of MRI and EEG findings Upload of actual images into the website

CT
HU measurements PLIC/Putamen Incidence of other findings Timing of the scan ~accuracy?

EEG and Prognostication

Correlate EEG with other prognosticators
NSE, S100b BIS1 SSEPs

Develop new intermediate endpoints for research

Hemodynamics & Metabolic

How important is BP support and is there really a fatal effect of early hypotension? Do pO2 and pCOs matter? Glucose pH How are hemodynamics monitored?

Satellite Surveys
Become focus groups of investigators with similar interests Help to define the standards of care & practice patterns in a given area Develop their own leadership and rules Own their satellite data We hope they will develop hypotheses and then get together to test them in prospective trials

 Some preliminary findings of INTCARCARDIOLOGY

Discussion
Describe process of survey development What worked and what did not