Exploring Strategies to Improve Cardiac Arrest Survival Proceedings of a Workshop (2017) / Chapter Skim
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3 Advancing Cardiac Arrest Research and Translation
3 Advancing Cardiac Arrest Research and Translation
Pages 37-52
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. A collaborative effort across the resuscitation field and translational research spectrum will be required to overcome persistent knowledge gaps, advance resuscitation science, and ultimately save lives, as described in Recommendations 6 and 7 (see Box 3-1)
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Findings at each phase can expand knowledge about the nature of heart disease and sudden cardiac arrest and death, Gibbon indicated.1 For example, discovery science explores the fundamentals of how the 1 As defined in Chapter 1, sudden cardiac arrest is "a severe malfunction or cessation of the electrical and mechanical activity of the heart .
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The latter phases of the spectrum (T3 and T4) include efforts to establish efficacy of new treatments, noted Gibbons, and to ensure that resuscitation science guides health care practice in real-world settings and communities.
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In the spirit of collaboration and information exchange, Gibbons urged workshop participants to consider the most important scientific questions to ask in preclinical models and clinical trials in order to reduce cardiac arrest mortality. Gibbons noted that NHLBI is in the final stages of its strategic visioning process, which used crowdsourcing to establish an agenda for the next 5 to 10 years.
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Creating a Research Network to Build Solutions Natasha Bonhomme, Genetic Alliance Genetic Alliance is a health advocacy organization that was formed 30 years ago as a resource for support groups and individuals who were interested in starting foundations, contributing to research, or getting involved with a particular health condition. Today, Genetic Alliance has a network of more than 10,000 organizations, individuals, and agencies that are involved in policy, advocacy, education, and research, said Natasha Bonhomme.
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When more than 12,000 users were asked about their level of trust in PEER, 90 percent reported being extremely confident and having complete trust in the system. Genetic Alliance has also launched a program called Community Engaged Network for All (CENA)
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could serve as exemplars for advancing cardiac arrest research and surveillance in the United States, said Nigel Hughes. For example, the Innovative Medicine Initiative (IMI)
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Lessons Learned and Successes In response to a comment, Hughes agreed that in order to advance research, the resuscitation field needs a large-scale data source that can be used to follow patients over decades, not just years or 30 days. Hughes noted that differing views of confidentiality and privacy in Europe provide linked data opportunities that are not currently possible in the United States.
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Environments and Conditions That Facilitate Cardiac Arrest Research Through Better Coordination, Oversight, and Strategy Demetris Yannopoulos, University of Minnesota The complexity of cardiac arrest at the pathophysiological level has resulted in many unanswered scientific questions, began Demetris Yannopoulos. For example, the physiology of low and no blood flow situations that lead to generalized tissue hypoxia or anoxia followed by reperfusion is not well understood, especially given the multisystem involvement of this process (e.g., heart, brain, lungs, kidneys)
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Yannopoulos emphasized that no progress can be made or improvements achieved without adequate resources. Across cardiac arrest clinical trials, Yannopoulos highlighted a persistent challenge with demonstrating statistical power, p values, and the magnitude of effect, which impact how study findings are interpreted and judged.
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Opportunities for Advancing Cardiac Arrest Research Advancing cardiac arrest research will require funding and new approaches to study design, said Yannopoulos. First, the scientific community and the nation must come together and "declare war on cardiac arrest." He added that a united front will also be needed to establish a national initiative that combines resources from funding agencies, organizations, and industry.
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Some members of the breakout sessions identified a number of alternative research methods that could be used to respond to methodological limitations and improve resuscitation research. For example, the resuscitation field could support the broader use of adaptive trials, stratified patient groups, and individualized protocols that are tied to the principles of patient-centered research.
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. BOX 3-2 Examples of Potential Partners for Accelerating Cardiac Arrest Research and Translation • AARP • American Heart Association • American Red Cross • Centers for Disease Control and Prevention • Community organizations and rotary clubs • Food and Drug Administration • Industry and private-sector organizations • Media • National Association of Emergency Medical Services Physicians • National Institutes of Health • Patient and disease-specific advocacy organizations • Patient-Centered Outcomes Research Institute • Patients and family members • Payers and insurance companies • Robert Wood Johnson Foundation • Sports organizations • Telecommunication companies (e.g., AT&T, Verizon)
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Presentation at the Dissemination Workshop on the Report Strategies to Improve Cardiac Arrest Survival: A Time to Act, Washington, DC. http://nationalacademies.org/hmd/~/media/Files/Activity%20Files/PublicHealth/ TreatmentofCardiacArrest/JULY%202016%20Workshop/Gibbons.pdf (accessed Octo ber 30, 2016)
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2016. Minnesota resuscitation consortium's advanced perfusion and reperfusion cardiac life support strategy for out-of-hospital refractory ventricular fibrillation.
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