Post resuscitative and initial utility in life saving efforts (pulse): A workshop executive summary

TY - JOUR

T1 - Post resuscitative and initial utility in life saving efforts (pulse)

T2 - A workshop executive summary

AU - Weil, M. H.

AU - Becker, L.

AU - Budinger, T.

AU - Kern, K.

AU - Nichol, G.

AU - Shechter, I.

AU - Traystman, R.

AU - Wiedemann, H.

AU - Wise, R.

AU - Weisfeldt, M.

AU - Sopko, G.

N1 - Funding Information: Conference participants believed that we are on the verge of new therapies and technologies to save thousands of lives currently lost following traumatic injury and circulatory or hypoxemic arrest. Two broad strategies should be pursued aggressively. First, existing therapies known to restore circulation, shorten the period of ischemia, and save lives should be refined to allow more rapid and more widespread deployment. Earlier and better CPR, rapid defibrillation, and prompt control of hemorrhage will lead to immediate improvement in survival. Second, we identified the need for an expansion of basic and applied research with a goal of identifying new therapies to minimize global ischemic insults. There was optimism that in the near future we will develop new resuscitation strategies, devices, and therapies which are life saving for patients who fall outside of the ‘effectiveness window’ of current treatment. Data from human survivors of ‘intractable’ ventricular fibrillation reveal that lives can be saved beyond the usual time limits. Cellular and tissue survival can now be extended significantly following previously ‘lethal’ ischemia; however the use of such therapy in humans awaits further research prior to translation into practice. Collectively, scientific evidence suggests that new treatments will increase the number of lives saved dramatically. We supported earlier emphasis on focal or regional ischemia, including myocardial infarction and stroke. We now urge recognition of the need to address the unique pathophysiology and options for improved treatment following global ischemia involving multiple regions and, actually, the entire body. New therapeutic interventions designed specifically to reduce ischemic reperfusion injury following restoration of blood flow are likely to come from the frontiers of molecular medicine, basic cardiovascular sciences, neurosciences, pharmacology, and epidemiology. New diagnostic techniques, and technological advances, including device development will be essential to this effort. Diverse disciplines, including the basic sciences, clinical sciences and biomedical engineering should be integrated to improve understanding of resuscitation physiology and the translation of new concepts into life saving medical practice. To advance the science and technology of saving lives we recommend specific items as most likely to produce a high yield in the near future: through new research initiatives, including collaborative research projects uniting basic and applied scientists. The focus should be on mechanisms of cellular injury and options for restoring the cell to normal following circulatory arrest and whole body ischemia. Novel basic science and molecular genetic approaches to resuscitation are intended to improve understanding of critical mechanisms of injury during and after ischemia. These may lead to new therapeutic interventions. The concept of reperfusion injury which may affect many body systems is paramount and prompts the development of integrated therapies and may even justify delaying defibrillation in specific ischemic settings. Subjects of special interest include: (a) cellular signaling processes, ionic control, and altered gene expression, induction, and regulation, that lead to, or are consequences of, activation of mediators of toxicity during global ischemia and in settings of reperfusion, (b) vascular control mechanisms during and following global ischemia and their pharmacologic modification, (c) molecular mechanisms underlying biological models of tolerance to ischemia leading to recovery including hibernation, arousal from hibernation, hypothermia, preconditioning, neonatal stress, and circulatory shock and (d) improved understanding of cardiopulmonary interactions during low flow states. Progress in management of traumatic injuries will follow better understanding of a) hemostasis at the site of injury, b) pharmacologic means for regional vasoconstriction, c) effects of traumatic injury on cardiopulmonary function and hemodynamic responses and d) the effect of fluid and blood flow management on the global tolerance of tissue hypoxia. These efforts should lead to basic and clinical research identifying directly the optimal conditions, fluids, and drugs for use during cardiopulmonary and post traumatic resuscitation. to facilitate serial studies on out-of-hospital cardiopulmonary resuscitation and trauma and to provide centralized coordination of protocols, data management, and common end points. Immediate research priorities include: a) a randomized trial of the early use of amiodarone after failed defibrillation, and b) national registries on clinical cardiac and trauma research with emphasis on uniformity of prehospital data collection, characterization of injuries and their severity, initial management, and outcomes. Other clinical studies of high priority include: a) a comparison of vasoactive drugs such as vasopressin and epinephrine against placebo during cardiac arrest, b) early, contrasted with delayed, artificial ventilation maneuvers, c) the role of mechanical resuscitation devices and airway adjuncts, d) intravascular fluid management after cardiac arrest or after the onset of circulatory shock following traumatic injuries, e) optimizing educational programs for lay and professional caregivers and f) a multicenter trial of rapid induction of moderate hypothermia during and after cardiopulmonary arrest based on technical advances in technologies for inducing hypothermia. including a) biosensors to acquire and monitor critical physiologic data during resuscitation; b) methods for rapid induction of controlled moderate hypothermia during resuscitation; c) methods to improve rapid vascular access; d) cardiac arrest alert and defibrillation technologies for broad public use; and e) new devices to produce blood flow during cardiac arrest. The development of new technologies will require the participation of basic and translational scientists, biotechnology experts, creative engineering talents, and pre-clinical animal testing. among investigators and federal funding agencies to more rapidly advance resuscitation research to improve outcomes. Emphasize Internet-based communications, support registries which document clinical experiences, communicate the deliberations of national organizations, and support interdisciplinary resuscitation meetings. The community of resuscitation researchers representing diverse disciplines should be identified and encouraged to communicate more effectively, including the use of the key word ‘resuscitation’ in publications. Finally, special targeted efforts are justified to overcome administrative restraints on life saving research. Acknowledgments Planning Task Force: Chairmen: Myron Weisfeldt MD, Columbia University, New York, NY and Robert Wise, MD, The Johns Hopkins University, Baltimore, MD; Barbara Alving, MD, National Heart Lung Blood Institute, Bethesda, MD; Lance Becker, MD, The University of Chicago, Chicago, IL; Jeffery Blumer, MD, Case Western Reserve University, Cleveland, OH; Roberto Bolli, MD, University of Louisville, Louisville, KY; Gerald Buckberg, MD, University of California, Los Angeles, CA; Thomas Budinger, MD PhD, University of California, Berkeley, CA; Wally Carlo, MD, University of Alabama, Birmingham, AL; Lawton Cooper, MD, National Heart Lung Blood Institute, Bethesda, MD; Richard Cummins, University of Washington, Seattle, WA; Avroy Fanaroff, MD, Western Reserve University, Cleveland, OH; Henry Halperin, MD, The Johns Hopkins University, Baltimore, MD; Richard Kerber, MD, University of Iowa, Iowa City, IA; Karl Kern, MD, University of Arizona, Tucson, AZ; Donald Landry, MD, Columbia University, New York, NY; David Lathrop, PhD, National Heart Lung Blood Institute, Bethesda, MD; John Marler, MD, National Institute of Neurological Disorders and Stroke, Bethesda, MD; Graham Nichol, MD, University of Ottawa, Ottawa, Ontario, Canada; Susan Niermeyer, MD, University of Colorado, Denver, CO; Pearl O'Rourke, MD, National Institutes of Health, Bethesda, MD; Paul Pepe, MD, University of Texas, Dallas, TX; Jeffery Perlman, MD, University of Texas, Dallas, TX; Donald Prough, MD, University of Texas, Galveston, TX; Ishaiahu Shechter, PhD, Uniformed Services University, Bethesda, MD; Scott Somers, PhD, National Institute of General Medical Sciences, Bethesda, MD; George Sopko, MD MPH, National Heart Lung Blood Institute, Bethesda, MD; Samuel Tisherman, MD, University of Pittsburgh, PA; Richard Traystman, PhD, The Johns Hopkins University, Baltimore, MD; Robert Vandre, DDS, Department of Defense, MD; Carole Webb, RN, National Heart Lung Blood Institute, Bethesda, MD; Max Harry Weil, MD PhD, Institute of Critical Care Medicine, Palm Springs, CA; Gail Weinmann, MD, National Heart Lung Blood Institute, Bethesda, MD; Herbert Wiedemann, MD, Cleveland Clinic Foundation, Cleveland, OH; Linda Wright, MD, National Institute of Child Health and Human Development, Bethesda, MD. Funding: Support for this workshop was provided by the NHLBI, NGMS, NINDS, NICHD, DOD, Agilent Technologies/Heartstream Operation (Seattle, Wash); Asmund S. Laerdal Foundation (Wappinger Falls, NY); Medtronic/PhysioControl (Redmond, Wash); Merck (Westpoint, Penn); Pfizer Pharmaceuticals Group (New York, NY); Wyeth-Ayerst Pharmaceuticals (Philadelphia, Penn). Max Harry Weil, MD PhD President, The Institute of Critical Care Medicine 1695 North Sunrise Way, Bldg #3 Palm Springs, CA 92262-5309 Tel: 760-323-6867 Fax: 760-323-6167 E-mail:weilm@aol.com Funding Information: The PULSE workshop was convened in recognition of the estimated loss of more than 1000 lives each day in the United States resulting from poor outcome following cardiopulmonary and trauma resuscitation. The purpose of the workshop was to provide an interdisciplinary forum on promising and novel life saving therapies in settings of cardiac, hypoxemic, and traumatic arrest and to identify the most promising new directions in cardiopulmonary and trauma resuscitation research. It was organized under a multi-agency initiative supported by National Heart Lung Blood Institute (NHLBI), National Institute of Child Health and Human Development (NICHD), National Institute of General Medical Sciences (NIGMS), and National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health together with the Food and Drug Administration (FDA), each within the Department of Health and Human Services (DHHS), and the Department of Defense (DOD). The workshop, held in Lansdowne Conference Center, Leesburg, VA, on June 29–30, 2000, provided the unique opportunity to convene domestic and international experts to chart a new course for future resuscitation research.

PY - 2001

Y1 - 2001

UR - http://www.scopus.com/inward/record.url?scp=0034909513&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034909513&partnerID=8YFLogxK

U2 - 10.1016/S0300-9572(01)00386-0

DO - 10.1016/S0300-9572(01)00386-0

M3 - Article

C2 - 11724009

AN - SCOPUS:0034909513

SN - 0300-9572

VL - 50

SP - 23

EP - 25

JO - Resuscitation

JF - Resuscitation

IS - 1

ER -