The report from the PULSE conference (Post-Resuscitative and Initial Utility in Life-Saving Efforts) says better resuscitation strategies could have a huge impact in the United States. More than 680 Americans die each day due to cardiac arrest, according to statistics from the American Heart Association.
“We have an opportunity to prioritize a science that will lead immediately, I think, to saving many, many lives, not only in the United States, but worldwide,” says Lance Becker, M.D., lead author of the report and a professor of clinical medicine in the emergency medicine section at the University of Chicago.
Resuscitation research focuses on investigating conditions that initiate, mediate and result when all of the body’s organs are deprived of oxygen. The PULSE report states that better methods are needed to lower the risk of injury and promptly restore cardiopulmonary (heart-lung) and cerebral (brain) function. “The intent is to minimize tissue injury and maximize tissue and organ repair,” the report says.
The recommendations evolved from a two-day conference held during the summer of 2000, during which a panel of resuscitation experts reviewed the status of resuscitation science and sought to chart a course to improve the science. Their recommendations:
· Develop a National Center for Resuscitation Research, a multiple agency collaboration focusing on resuscitation science and related activities.
· Implement programs that prioritize support for resuscitation research.
· Establish a support system to promote and coordinate basic and clinical research in resuscitation.
· Establish databases of clinical cases of resuscitation.
· Prioritize new resuscitation strategies.
· Form resuscitation expert panels to review National Institutes of Health (NIH) applications.
· Promote professional and public education and training in resuscitation medicine.
“Coronary heart disease is the single largest killer of Americans, but it gets less than half the funding devoted to cancer research,” says co-author Max Harry Weil, M.D., Ph.D., of the Institute of Critical Care Medicine in Palm Springs, Calif. “Within that limited scope of funding for heart disease research, the area of cardiopulmonary resuscitation historically has had negligible funding.”
The 2000 conference has since attracted the attention and assistance of key members of the National Institutes of Health to improve funding for resuscitation research, Weil adds. A principal objective of the PULSE initiative was to stimulate research into the underlying biology and physiology of cardiac arrest. Progress toward developing more effective resuscitation strategies has been hampered by a lack of understanding about the basic processes involved in cardiac arrest.
One research priority listed by the PULSE expert panel includes investigating the processes underlying “hibernation physiology.” For instance, hibernating animals tolerate ischemia (loss of blood flow) and reperfusion (restoration of blood flow) without injury and therefore represent a potentially valuable model for studying ways to improve outcomes from ischemic injury, researchers say.
Based on experience in animal studies, the heart rate decreases to as little as 5 percent of normal during hibernation – a level that would be lethal during active states. The panel states that this area of research is intriguing because it appears that the heart is not damaged during the prolonged “ischemic” state, nor does the cardiac rhythm deteriorate.
Other research priorities cited by the authors include improved understanding of existing and proposed therapies for cardiac arrest, investigating the therapeutic potential of hypothermia (cooling) and controlled reperfusion, developing better experimental models to study cardiac arrest, developing sensors to detect critical restrictions in blood flow; and organizing research networks to promote collaborative investigations.
“We are on the brink of major scientific progress in the field of resuscitation. Investment at this critical point in time will lead to important advances,” says Becker.
Co-authors of the PULSE Initiative report are Myron L. Weisfeldt, M.D.; Richard Traystman, Ph.D.; Robert Wise, M.D.; Thomas Budinger, M.D., Ph.D.; James Carrico, M.D.; Karl Kern, M.D; Graham Nichol, M.D.; Ishaiahu Shechter, Ph.D.; Herbert Wiedemann, M.D.; Carole Webb, M.S.N., C.C.R.N.; and George Sopko, M.D., M.P.H.
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