Showing 6 ideas for tag "resuscitation"

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 »

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 2: Reduce Human Disease

Goal-directed versus Fixed-ratio plasma resuscitation in surgical (non-trauma) hemorrhage

For surgical patients meeting criteria for the critical RBC administration threshold (CAT) due to an associated coagulation disorder, which hemostatic resuscitation strategy (goal-directed versus ratio-based) is superior?

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

Details on the impact of addressing this CQ or CC

Perioperative hemorrhage remains a significant concern. Coagulopathy frequently develops in the setting of surgical hemorrhage and the optimal strategy for addressing this issue remains a matter of debate.
Military experience suggests the application of ratio-based plasma transfusion practices may improve clinical outcomes in the setting of massive hemorrhage. However, numerous concerns (e.g. survival bias, uniqueness of a military population, risk for adverse events related to high-volume plasma transfusion) preclude the broad generalization of such strategies to non-trauma surgical populations.
Goal-directed hemostatic resuscitation strategies (e.g. coagulation management based upon the results of hemostasis testing) have shown promise in specific surgical environments such as cardiac surgery and liver transplantation. However, definitive direct comparisons between goal-directed strategies and alternative approaches such as fixed-ratio plasma transfusion have not been performed. Moreover, the role of such strategies in more heterogeneous surgical populations remains uncertain. To better define the optimal approach to plasma transfusion strategies in the setting of intraoperative (non-trauma) hemorrhage, we propose a multicenter clinical trial directly comparing fixed-ratio and goal-directed plasma resuscitation strategies in the operating room environment.

Feasibility and challenges of addressing this CQ or CC

Surgical patients with increased risk of hemorrhage may be targeted to improve subject recruitment (e.g. cardiac surgery, liver transplantation, aortic vascular surgery, multi-level instrumented spinal fusions or tumor resections, etc). Therefore, an adequately sized study population is likely to be present in a multicenter study and we believe such a trial would be feasible with NHLBI support.

To further enhance the feasibility of identifying a surgical population experiencing significant hemorrhage in a time-efficient manner, predictive algorithms such as the critical RBC administration threshold (CAT) could be also be employed.

The optimization of decisions related to plasma transfusion has the potential to improve not only clinical outcomes, but also healthcare resource utilization. Therefore, the outcomes of a trial in this domain could include both patient-important outcomes (e.g. mortality, bleeding complications), as well as outcomes related to healthcare utilization (e.g. total blood products consumed, hospital length of stay).

Name of idea submitter and other team members who worked on this idea Daryl J. Kor, MD and Walter H. Dzik, MD for the 2015 NHLBI State of the Science in Transfusion Medicine.

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11 net votes
30 up votes
19 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 »

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

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4 up 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?

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

National cardiac arrest registry

Cardiac arrest registries are needed to measure and improve the process and outcome of resuscitation care and provide a platform for exploring insight into risk factors, prognosis, and the effectiveness of interventions for out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA).

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 registry provide contemporary data of local, regional and nation wide EMS practices in managing OHCA to address and develop successful resuscitation strategies across gender, age and race categories.

Feasibility and challenges of addressing this CQ or CC

combining ROC (Resuscitation Outcomes Consortium) and CARES (Cardiac Arrest Registry to Enhance Survival), the two largest North American existing OHCA registries have different (regional) foot print, quality control measures and thus goals. CARES was developed as U.S. based surveillance registry across majority of states and not a research database; therefore, collected only the minimum number of data elements that are known to be essential in the response and treatment of OHCA. ROC is a North American registry conducted at 10 major regions with a detailed and high quality CPR process data providing not only the OHCA rates but also detailed CPR characteristics. Combining a large geographic foot print with sites with established quality controls would offer insight into rural, suburban and urban OHCA resuscitation dynamics on which resuscitation strategies would be based.
It is well recognized that there are marked variations in survival from OHCA and IHCA among centers as well temporal trends, however, factors associated with it are incompletely understood. Ongoing quality data are needed to advance our understanding of resuscitation care, as well as variations in EMS/ED practices.

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

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-8 net votes
9 up votes
17 down votes
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Goal 3: Advance Translational Research

Parameters for monitoring perfusion during CPR

What physiologic parameters (and related technologies) might be useful to monitor and assess the adequacy of perfusion during CPR and to potentially guide therapy during resuscitation?

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 net votes
1 up votes
3 down votes
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