Rescuscitation Institute

Every year approximately 330 000 individuals in the United States and 700 000 in Europe suffer an episode of sudden cardiac arrest outside the hospital. Efforts to reestablish life are formidably challenging, requiring not only that cardiac activity be reestablished but that injury to vital organs be prevented, minimized, or reversed. Current resuscitation methods yield an average survival rate to hospital discharge with intact neurological function that approaches only 5% nationwide. Emergency Medical Services (EMS) systems can initially reestablish cardiac activity in approximately 30% of victims at the scene; however, more than 30% die before reaching a hospital. Of those admitted to a hospital, nearly 75% die before hospital discharge as a consequence of myocardial dysfunction, neurological dysfunction, systemic inflammation, intercurrent illnesses, or a combination thereof.

Poor outcome reflects, at least in part, failure to vigorously implement key components of the so-called "Chain of Survival." Substantial improvement in survival reaching 20% has been reported when all components of the Chain of Survival are vigorously implemented, which includes:

Recognition of warning signs heralding an episode of sudden cardiac arrest or prompt recognition of the episode itself (i.e., unresponsiveness with abnormal breathing or gasping) followed by activation of the EMS system (e.g., by dialing 911).
Initiation of quality CPR (Hands-Only CPR for adult victims with arrest of presumed cardiac origin) and use of automated external defibrillators (AEDs) by bystanders pending arrival of professional rescuers.
Continuation of CPR by an EMS system capable of delivering hi-quality CPR (e.g., minimally interrupted compressions, enhancement of venous return, physiological feedback, etc.).
Transport to a center capable and committed to manage the post-resuscitation phase having 24/7 capability for providing (1) emergency coronary interventions and (2) therapeutic hypothermia in a critical care environment able to monitor and support vital organ function.
A program of continuous quality improvement based on monitoring outcome and process variables.

The Resuscitation Institute at Rosalind Franklin University is committed to improve outcomes after cardiac arrest through a multifaceted approach that involves not only efforts to promote vigorous implementation of the Chain of Survival but also education and research on novel and more effective methods for cardiac resuscitation.

The Resuscitation Institute is directed by Raúl J. Gazmuri MD, PhD, FCCM. Professor of Medicine and Associate Professor of Physiology & Biophysics at Rosalind Franklin University and Section Chief of Critical Care Medicine at the Captain James A. Lovell Federal Health Care Center.

Research activities are carried out at the University by Jeejabai Radhakrishnan, PhD, with the assistance of clinical fellows and medical students; and abroad in collaboration with a Dr. Iyad M. Ayoub, PhD in Amman, Jordan along with international collaborators.

CURRENT AND RECENT FUNDED RESEARCH (2008 - PRESENT)

Investigation of a New NHE-1 Inhibitor for Resuscitation from Cardiac Arrest; funded by Boehringer Ingelheim Pharmaceuticals, Inc. The project is designed to assess the effects of blocking the sarcolemmal sodium-hydrogen exchanger isoform-1 (NHE-1) on left ventricular myocardial distensibility during CPR (2008-2009).

Volume-Controlled Manual Ventilation during Resuscitation from Cardiac Arrest; funded by the Dessinier Corporation. The project is designed to assess in a pig model of ventricular fibrillation the effects of ventilatory volumes on the blood flow and pressures generated by chest compression (2009-2010).

Vitamin-C Preserves Myocardial Distensibility during Resuscitation from Cardiac Arrest; funded by Zdravstveni Dom. Dr. Adolfa Drolca, Maribor, Slovenia. The project is designed to assess whether myocardial effects of vitamin-C – for its antioxidant effect – could be beneficial for resuscitation from cardiac arrest when administered coincident with the start of CPR (2009-2010).

Mechanisms of Cytochrome c Release during Cardiac Resuscitation; funded by a gift for cardiovascular research administered by the Hines VA Research Service. The project is designed to examine the role of mitochondria during resuscitation from cardiac arrest by altering the in vivo expression of key mitochondrial proteins (i.e., cyclophilin-D and Bcl-2) using cardioselective viral gene transfer techniques (i.e., AAV9) (2010-2011).

Myocardial Effects of Erythropoietin during Resuscitation from Cardiac Arrest; funded by a VA Merit Review Grant. The project is designed to assess in a swine model of ventricular fibrillation and closed-chest resuscitation the myocardial mechanisms and effects of erythropoietin when administered at the beginning of CPR (2010-2013).

Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic Shock; funded by the Defense Medical Research and Development Program (DMRDP), Applied Research and Technology Development Award (ARADTA). The project is designed to assess in a swine model of hemorrhagic shock the effect of erythropoietin on vital organ function (2010-2013).

SELECTED PUBLICATIONS (2008-PRESENT)

Book Chapters

Gazmuri RJ. [Electrophysiology of Lethal Arrhythmias]. In: Cardiopulmonary Cerebral Resuscitation and Emergency Cardiovascular Care: From Basic Science to Clinical Practice. Chinese Textbook, 2008, pp.125-137.

Gazmuri RJ. [Prevention and Management of Post-Resuscitation Myocardial Dysfunction]. In: Cardiopulmonary Cerebral Resuscitation and Emergency Cardiovascular Care: From Basic Science to Clinical Practice. Chinese Textbook, 2008, pp.397-409.

Gazmuri RJ, Correa BM. Cardiovascular Function and Vascular Tone: Physiology for ECC. In: Field JM (Editor-In-Chief); Kudenchuk PJ, O'Connor RE, Vanden Hoek TL (AHA associate editors); Bresler MJ, Mattu A, Silvers SM (ACEP associate editors). Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins, 2009 pp.395-407.

Peer Reviewed

Ayoub IM, Radhakrishnan J, Gazmuri RJ. Targeting mitochondria for resuscitation from cardiac arrest. Crit Care Med 2008;36:S440-S446.

Radhakrishnan J, Ayoub IM, Gazmuri RJ. Activation of caspase-3 may not contribute to post-resuscitation myocardial dysfunction. Am J Physiol Heart Circ Physiol 2009;296:H1164-74.

Grmec S, Strnad M, Kupnik D, Sinkovič A, Gazmuri RJ. Erythropoietin facilitates the return of spontaneous circulation and survival in victims of out-of-hospital cardiac arrest. Resuscitation 2009;80:631-7.

Ayoub IM, Kolarova J, Gazmuri RJ. Cariporide given during resuscitation promotes return of electrically stable and mechanically competent cardiac activity. Resuscitation 2009;81:106-110.

Cave DM, Gazmuri RJ, Otto CW, Nadkarni VM, Cheng A, Brooks SC, Daya M, Sutton RM, Branson R, Hazinski MF. Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S720-28.

Radhakrishnan J, Kolarova J, Ayoub IM, Gazmuri, RJ. AVE4454B – a novel sodium-hydrogen exchanger isoform-1 inhibitor – compared less effective than cariporide for resuscitation from cardiac arrest. Translational Research [In Press].

Non-Peer Reviewed

Gazmuri RJ, Tandon M. Cardiopulmonary resuscitation: From flying blind to flying right. Crit Care Med 2008;36:357-358.

Alvarez-Fernandez J-A, Gazmuri RJ. Mortalidad evitable por parada cardíaca extrahospitalaria [Avoidable mortality after out-of-hospital cardiac arrest]. Med Clin (Barc) 2008;130:710-4.

Gazmuri RJ, Alvarez-Fernandez J-A. Tendencias en resucitación cardiopulmonar [Trends in cardiopulmonary resuscitation]. Med Intensiva 2009;33:31-9.

Ayoub IM, Radhakrishnan J, Gazmuri RJ. Caspase-3 may not play a role during cardiac arrest and resuscitation. In: Grmec Š (Ed.) Acute Conditions: Signs, Symptoms, Syndromes, Differential Diagnosis and Management. Proceedings and Algorithms of the 4^th International Seminar on Acute Medicine. Maribor, Slovenia, October 15-17, 2009, pp.146-56.

Gazmuri RJ, Ayoub IM, Radhakrishnan J. NHE-1 inhibitors and erythropoietin for maintaining myocardial function during cardiopulmonary resuscitation. In: Grmec Š (Ed.) Acute Conditions: Signs, Symptoms, Syndromes, Differential Diagnosis and Management. Proceedings and Algorithms of the 4^th International Seminar on Acute Medicine. Maribor, Slovenia, October 15-17, 2009, pp.157-69.

Gazmuri RJ, Ayoub IM, Radhakrishnan J. Cardiopulmonary resuscitation: From flying blind to flying right. In: Grmec Š (Ed.) Acute Conditions: Signs, Symptoms, Syndromes, Differential Diagnosis and Management. Proceedings and Algorithms of the 4^th International Seminar on Acute Medicine. Maribor, Slovenia, October 15-17, 2009, pp.170-5.

Gazmuri RJ, Ayoub IM. Reply to Letter to the Editor by Faybik, Peter MD, Lahner, Daniel MD, and Schramm, Wolfgang MD entitled "An outlasting error of Ernest Henry Starling for at least 83 years in the medical literature". Resuscitation 2010, doi:10.1016/j.resuscitation.2010.07.017 [In Press].

HONORS AND AWARDS (2008 – PRESENT)

Resuscitation/Critical Care Best Abstract Award presented by the American Heart Association's Council on Cardiopulmonary, Perioperative and Critical Care. American Heart Association Scientific Sessions 2008. November 11, New Orleans, Louisiana. Erythropoietin facilitates the return of spontaneous circulation and subsequent ICU admission in victims of out-of-hospital cardiac arrest. Grmec S, Strnad M, Kupnik D, Sinkovic A, Marc G, Gazmuri RJ.

Cournand and Comroe Young Investigator Prize in Cardiopulmonary and Critical Care (one of 5 finalists), Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. American Heart Association Scientific Sessions 2009. November 17, Orlando, Florida. The mitochondrial permeability transition pore opens during ventricular fibrillation in a rat model of closed chest resuscitation. Ayoub IM, Radhakrishnan J, Upadhyaya MP, Gazmuri RJ.

Second Prize Poster Winner at the Annual Hines/North Chicago VA Research Day. April 29, 2010. Edward Hines, Jr VA Hospital, Hines, IL. Preservation of left ventricular myocardial distensibility using a novel sodium-hydrogen exchanger isoform-1 inhibitor markedly enhances the hemodynamic efficacy of chest compression. Ayoub IM, Upadhyaya MP, Radhakrishnan J, Gazmuri RJ.

** Recent Highlights**

Recognition of warning signs heralding an episode of sudden cardiac arrest or prompt recognition of the episode itself (i.e., unresponsiveness with abnormal breathing or gasping) followed by activation of the EMS system (e.g., by dialing 911).
Initiation of quality CPR (Hands-Only CPR for adult victims with arrest of presumed cardiac origin) and use of automated external defibrillators (AEDs) by bystanders pending arrival of professional rescuers.
Continuation of CPR by an EMS system capable of delivering hi-quality CPR (e.g., minimally interrupted compressions, enhancement of venous return, physiological feedback, etc.).
Transport to a center capable and committed to manage the post-resuscitation phase having 24/7 capability for providing (1) emergency coronary interventions and (2) therapeutic hypothermia in a critical care environment able to monitor and support vital organ function.
A program of continuous quality improvement based on monitoring outcome and process variables.