Goal 3: Advance Translational Research

Paradigm shift in cardiac arrest rhythm and resuscitation

What resuscitation strategies targeted toward pulseless electrical activity (PEA)/asystole would be successful in preventing cardiac arrest (CA)? Furthermore, what are animal models of PEA/asystole, what is responsible of this major shift in the underlying rhythm of CA, and what is the phenotype?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

There is a critical need to address continuous shift in the primary rhythm of CA from VT/VF to PEA/asystole with new strategies to improve survival.

Feasibility and challenges of addressing this CQ or CC :

Data from major registries, such as ROC, CARES and other provide the needed population base and platform to analyze existing strategies, explore and develop and test new resuscitation strategies.

With the continuous decline in VT/VF proportion as the primary rhythm leading to cardiac arrest (CA), pulseless electrical activity (PEA) and asystole have become the dominant rhythms in CA. In early 70's VT/VF constituted more than half of the CA, which currently is ~ 28%. Major effort and defibrilation and resuscitation strategies have been successfully targeted toward VT/VF. The survival of PEA/asystole is dismal.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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Goal 2: Reduce Human Disease

Genetic risk factors for sudden cardiac death

What are the genetic risk factors for sudden cardiac death and failure to respond to CPR and defibrillation?

Submitted by (@rebecca.lehotzky)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : AHA Staff & Volunteers

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2 up votes
4 down votes
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Goal 3: Advance Translational Research

What is the optimal way to improve cardiac arrest resuscitation?

Sudden Death from cardiac arrest and gaps in knowledge of emergency cardiovascular care are the #1 killer of more than 400,000 Americans each year. This epidemic of death and disability is largely ignored and underfunded by NIH and all funding agencies and kills more than HIV, Cancer, Diabetes, and infectious diseases. There is no national registry of cardiac arrest, no mandatory reporting, and poor funding for both fundamental, ...more »

Submitted by (@nadkarni)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Answering this question will save more lives and quality of life-years than all other infectious diseases in North America. The potential interventions are well developed and we need more fundamental, translational and implementation science to impact this most significant problem. An upcoming IOM report on needless deaths resulting from cardiac arrest is anticipated to be published in 2015.

Feasibility and challenges of addressing this CQ or CC :

Very feasible, just needs support and funding. A call to arms is being issued by the American Heart Association and Institute of Medicine. The roadmap is outlined, and all we need to do is follow the roadmap.

Name of idea submitter and other team members who worked on this idea : Vinay Nadkarni MD

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19 net votes
37 up votes
18 down votes
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Goal 4: Develop Workforce and Resources

Training the public to respond to cardiac arrest

What is the best way to train the public to recognize sudden cardiac arrest, perform CPR and utilize an AED?

Submitted by (@rebecca.lehotzky)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : AHA Staff & Volunteers

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3 net votes
6 up votes
3 down votes
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Goal 2: Reduce Human Disease

Cardiovascular dysfunction in geriatric trauma patients

There is too little research funding addressing cardiovascular dysfunction in geriatric trauma patients. There have been little interest in funding this work. Yet, the geriatric population is growing. Geriatric trauma patients are predominantly women. Historically, the trauma societies provide guidance for diagnosis and treatment of severe trauma. However, "trauma guidance" historically was the same for children, ...more »

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Document and understand the role of cardiac dysfunction in contributing to morbidity and mortality of geriatric trauma patients.

 

Reduce mortality rates in geriatric trauma patients.

Feasibility and challenges of addressing this CQ or CC :

Little research has been conducted to understand the role of cardiac dysfunction in elderly trauma patients. These patients may be intubated and treated with pain meds, so the normal symptoms of cardiac ischemia are silenced. Because 12 lead ECGs or cardiac enzymes are not routinely collected in these patients after admission, the question is what types of cardiac dysfunction occur and can they be prevented?

 

While evidence is scant, we conducted a structured chart review of WMD Shock Trauma patients' medical records in fiscal year 1999 data. Mean age was 76 and mean ISS of 24. In reviewing charts we found 71% of patients had one or more risk factors for ischemic heart disease (beyond age) and 30% had a history of ischemic heart disease. On admission 29% had ECG changes consistent with acute cardiac ischemia, but ischemic changes were noted equally between patients with and without a history of IHD. Cardiac enzymes were ordered for 45% of patients and 19% were positive. We found that patients with acute cardiac ischemia on admission (ECG or enzymes) had more adverse in-hospital cardiac events than those without ischemia on admission. Patients experiencing adverse events were significantly more likely to die.

 

We believe these findings suggest a substantial role of cardiac dysfunction in this population, but we were unable to generate interest in the topic.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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1 up votes
32 down votes
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Goal 2: Reduce Human Disease

Improving the Detection and Treatment of Cardiac Sarcoidosis

Sarcoidosis afflicts young adults, particularly African Americans and females, and often causes chronic disability or death. Cardiac sarcoidosis (CS) was once considered to be a rare disease manifestation; however, with the development of improved diagnostic testing procedures, such as MRI and PET scans, CS is now known to afflict up to 40% of sarcoidosis patients and is recognized as a major cause of death. The current ...more »

Submitted by (@elliott.crouser)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Improved detection of cardiac sarcoidosis (CS) is necessary to screen for CS in the sarcoidosis population and to identify those patients requiring further testing and personalized treatments. The optimal CS detection tool would be able to quantify the burden of cardiac disease, and would provide insight into disease activity (e.g., acutely active/reversible versus inactive/irreversible cardiac disease). Once validated, the CS detection tool would be used to risk stratify patients for the purpose of initial and subsequent treatments.

Feasibility and challenges of addressing this CQ or CC :

Current and evolving imaging techniques have rapidly improved the detection of sarcoidosis, so these technologies are feasible. However, it is unclear how to interpret the results of these novel imaging techniques in the context of treating humans with sarcoidosis. A number of challenges remain (e.g., how to distinguish active from inactive cardiac sarcoidosis, and how to objectively assess disease severity as relates to the risk of serious adverse cardiac events). A strength of this project being that this field is poised for clinical investigations designed to improve cardiac sarcoidosis detection and treatment using existing technologies.

Name of idea submitter and other team members who worked on this idea : Elliott Crouser, Subha Raman, Nabeel Hamzeh, Lisa Maier

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-4 net votes
2 up votes
6 down votes
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Goal 2: Reduce Human Disease

Why does loss of endoglin in adult blood cells lead to cardiac hypertrophy in HHT patients

Liver arteriovenous venous malformations creates a high flow shunt that over time creates high output cardiac failure with no effective treatments.

Submitted by (@mariannes.clancy)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Marianne Clancy MPA, Chris Hughes PhD

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1 net vote
1 up votes
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Goal 2: Reduce Human Disease

Benefits of intraosseous access on outcomes from OHCA

Vascular access is a challenge in the setting of out-of-hospital cardiac arrest (OHCA). The failure of medications to impact outcomes may be in part related to the delay in drug delivery from the IV route. EMS systems have adopted intraosseous (IO) access but it is not clear if these are affecting outcome and there has been no large RCT. The current IO access devices are expensive and use different routes (sternal, tibia, ...more »

Submitted by (@dayam0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

At over a 100 dollars per device, the costs of using an IO line for estimated 300K arrests in the United States is 30 million dollars. We need to know if this route works and the optimal location for placement.

Feasibility and challenges of addressing this CQ or CC :

Funding, willingness to study this in a well designed clinical trial

Name of idea submitter and other team members who worked on this idea : Mohamud Daya

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2 up votes
2 down votes
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Goal 3: Advance Translational Research

Cellular & molecular effects of diabetes on the heart

Diabetes increases cardiovascular disease risk factors. Evidence suggests that diabetes alters contractile and electrical function of the heart, but little is known about the cellular and molecular basis for these changes.

Submitted by (@catherine.proenza)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Develop more effective treatments for cardiovascular disease in patients with diabetes and metabolic syndrome.

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21 net votes
36 up votes
15 down votes
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