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 »
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.
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 »
How do we eliminate disparities in cardiac arrest care?
Can surveillance systems be developed to prevent in-hospital cardiac arrest outside the ICU?
Should out-of-hospital cardiac arrest care be regionalized to specialized centers similar to trauma, STEMI, and stroke?
What is the best way to train the public to recognize sudden cardiac arrest, perform CPR and utilize an AED?
Can personal surveillance systems to prevent “unwitnessed” cardiac arrest improve outcomes?
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?
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?
Which, if any, pharmacologic and non-pharmacologic therapies are useful and effective in cardiac arrest due to non-shockable rhythms?
Is intra-arrest therapeutic hypothermia feasible during CPR, and does it improve outcomes?
What is the optimal dose and duration of post-cardiac arrest hypothermic targeted temperature management?
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 »
What is the sequence and time course of molecular events that cause irreversible cardiovascular and neurologic dysfunction during and after cardiac arrest?