Division of Cardiovascular Diseases Strategic Plan

Goals in Cardiovascular Clinical Problems or Disease States

2.3c. Improve the dismal (5-10 percent) and stagnant success rate of out-of-hospital cardiac and life-threatening trauma resuscitation

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Out-of-hospital cardiac arrest and life-threatening traumatic injury are common, serious, and costly public health problems. More than 90 percent of sudden cardiac arrest and 60 percent of severe traumatic injury patients do not survive their acute event. Sudden cardiac death is a major health problem, causing about 330,000 deaths each year among U.S. adults before they can reach a hospital or emergency room. Trauma is the leading cause of death among children and all individuals to age 34 years, the leading cause of loss of productive life-years of any disease, with societal costs estimated at $469 billion dollars annually. Thus, even a modest improvement in resuscitation survival with neurologic competence will translate into a substantial public health benefit.

Strategies to Accomplish this Goal May Entail:

Basic Research:

  • Investigate molecular, cellular, organ and system pathophysiology of acute CV/traumatic collapse and ischemic injury and related molecular genetic pathways to improve understanding of reperfusion injury in the early post-resuscitation interval.
  • Study the effects of hibernation physiology and its implications for therapeutic hypothermia.
  • Investigate immunological targets, including the coagulation cascade and mediators of cell injury and death, for potential therapeutic value.
  • Investigate micro-heterogeneity in the biology of various endothelial beds and their differential responsiveness to vaso-active agents.

Translational Research:

  • Investigate strategies to generate greater blood flow during cardiopulmonary resuscitation in animal models.
  • Develop invasive and noninvasive circulatory support systems.
  • Investigate strategies for induction of hypometabolic states, such as hypothermia, together with the option of reducing the effects of free radicals.
  • Expand biomedical engineering efforts through focused programs and commercial partnership mechanisms to improve biosensors for the measurement of blood pressure, brain and heart blood flow and metabolism.
  • Improve the early detection of cardio-pulmonary arrest, in the interest of reducing delays in resuscitative efforts.
  • Advance defibrillator technology and application.

Clinical Research:

  • Conduct multidisciplinary research that focuses on reducing tissue injury following cardiac, asphyxial, and traumatic arrest and/or hastening restoration of effective circulation following CV collapse.
  • Establish and maintain regional, national and international registries on traumatic and/or CV arrest.
  • Conduct studies on pharmacologic interventions to establish and maintain hemodynamic and electrical stability, focusing on:
    • improved understanding of currently used and newly proposed agents in the management of cardiac arrests;
    • the prevention of diffuse coagulopathies, especially under conditions of reduced blood flow as in trauma and hypovolemia of other causes;
    • minimizing endothelial injury
    • minimizing parenchymal organ injury.
  • Conduct studies on the induction of hypometabolic states together with the option of reducing the effects of free radicals.
  • Test and apply innovative design concepts for early monitoring and intervention in out-of-hospital settings. For example, biochemical and electrical sensors and sensor arrays that provide vital real-time information on physiologic status and guide initial and ongoing resuscitative interventions.
  • Study and validate improved techniques for rapid vascular access following cardiac arrest and/or trauma.
  • Continue and optimize waiver-of-informed-consent research and develop effective community educational strategies.
  • Expand interagency collaborations to overcome the obstacles in out-of-hospital research.

Contributing Sources:

September 2008

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