Goal 2: Reduce Human Disease

Pulseless Electrical Activity (PEA) - replacing VF/VT

As VF/VT rates continue to decrease in cardiac arrest to levels below 25%, the importance of understanding the pathways and epidemiology of PEA gains public health importance. Additionally, there is a need to determine the co-morbidities and/or pharmacologic agents that contribute to the causation of this rhythm.

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 :

Greater understanding of PEA would lead to better treatment (good CPR only treatment currently) and higher survival rate in CA

Feasibility and challenges of addressing this CQ or CC :

How will be treat the majority of cardiac arrest when it becomes PEA?

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

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-9 net votes
7 up votes
16 down votes
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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

Voting

-4 net votes
7 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

Optimizing therapeutic hypothermia

What is the optimal dose and duration of post-cardiac arrest hypothermic targeted temperature management?

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

Voting

-3 net votes
1 up votes
4 down votes
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Goal 2: Reduce Human Disease

Developing techniques to monitor neurologic injury after cardiac arrest

Can techniques to monitor brain injury and recovery in post-cardiac arrest patients be developed to optimize post-cardiac arrest care and enable reliable neuroprognostication?

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

Voting

-1 net votes
2 up votes
3 down votes
Active

Goal 3: Advance Translational Research

Surveillance systems to prevent in-hospital cardiac arrest

Can surveillance systems be developed to prevent in-hospital cardiac arrest outside the ICU?

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

Voting

-1 net votes
2 up votes
3 down votes
Active

Goal 4: Develop Workforce and Resources

Specialized centers for cardiac arrest care

Should out-of-hospital cardiac arrest care be regionalized to specialized centers similar to trauma, STEMI, and stroke?

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

Voting

-1 net votes
2 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Improving devices for cardiac arrest

Can improved catheters, pumps and oxygenators for extracorporeal cardiopulmonary resuscitation be developed that will make feasible widespread implementation for refractory in-hospital and out-of-hospital cardiac arrest?

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

Voting

-2 net votes
2 up votes
4 down votes
Active

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

Voting

19 net votes
37 up votes
18 down votes
Active

Goal 2: Reduce Human Disease

Does epinephrine improve outcomes in OHCA

Epinephrine is the primary drug that is used in resuscitation but observational studies and a few small RCT suggest that it improves short term but not long term outcomes. Factors such as timing, dose, quality fo CPR and post-resuscitation care all confound the issue. Large RCTs conducted at multiple centers are desperately needed to address this question.

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 :

If short terms outcomes are improved but not long term outcomes, we are only adding costs and not improving population health

Feasibility and challenges of addressing this CQ or CC :

Will require a large prehospital clinical trials network and ideally also a current national registry of OHCA to address secular changes in other confounding variables

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

Voting

1 net vote
3 up votes
2 down 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

Voting

0 net votes
2 up votes
2 down votes
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Goal 2: Reduce Human Disease

Problem of sudden cardiac death

Among major causes of cardiac mortality cardiac arrest stands as a cause of death that rivals all other causes in terms of frequency. There has been at best only modest improvement in resuscitation over recent years. No wonder with so little NHLBI funding going into this cause compared to acute MI and heart failure. Hopefully the IOM report on cardiac resuscition will be a call to action that will highlight these NIHBI ...more »

Submitted by (@mlw500)

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

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0 net votes
4 up votes
4 down votes
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Goal 2: Reduce Human Disease

Reducing Variability in Outcomes from Out of Hospital Cardiac Arrest

Out of hospital cardiac arrest remains a major cause of mortality in the United States and there is a large variability in survival within communities. We need to better understand the reasons for this variability which include patient, event, EMS system and care processes and work as a nation to reduce the variability but adopting best practices and actively addressing the barriers to change which can be social, cultural, ...more »

Submitted by (@dayam0)

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

Details on the impact of addressing this CQ or CC :

If we could reduce variability, we would save more lives and also enhance the chain of survival in our communities

Feasibility and challenges of addressing this CQ or CC :

will require that we connect multiple parts of the community including the population at risk, public health services and the health care system which is not always easy in silo systems or fragmented health care systems

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

Voting

0 net votes
2 up votes
2 down votes
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