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Introduction
Current institution
Publications
Publications (66)
The American Heart Association (AHA) introduced public access defibrillation more than 30 years ago. Since then, we have seen the growth of public access defibrillation programs across many settings within communities. However, despite high expectations that the availability of automated external defibrillators (AEDs) and more integrated public acc...
Objectives
We aimed to assess the attitudes and perceptions of scholarly activity (SA) practices among emergency medicine (EM) physicians who are engaged in training residents. This study examined the belief and need for modern‐day SA, potential barriers, and department resources provided.
Methods
We conducted a descriptive cross‐sectional survey...
Background
Post-cardiac arrest syndrome (PCAS) presents a multifaceted challenge in clinical practice, characterized by severe neurological injury and high mortality rates despite advancements in management strategies. One of the important critical aspects of PCAS is post-arrest lung injury (PALI), which significantly contributes to poor outcomes....
This scientific statement presents a conceptual framework for the pathophysiology of post–cardiac arrest brain injury, explores reasons for previous failure to translate preclinical data to clinical practice, and outlines potential paths forward. Post–cardiac arrest brain injury is characterized by 4 distinct but overlapping phases: ischemic depola...
Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA’s advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scienti...
Study objectives:
We aimed to evaluate the duration and frequency of communication between EMS (Emergency Medical Services) and ED (Emergency Department) staff during handoff and the subsequent time to critical cardiac care (rhythm determination, defibrillation) using CA (cardiac arrest) video review.
Methods:
A single-center retrospective study...
Background:
To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of RCT participants followed prospectively for 90 days after an E.D. visit for acute back or kidney stone pain.
Methods:
One thousand three hundred-one individuals were randomized during an...
Antibody-based strategies have been attempted to antagonize early cytokines of sepsis, but not yet been tried to target inducible late-acting mediators. Here, we report that the expression and secretion of procathepsin-L (pCTS-L) was induced by serum amyloid A (SAA) in innate immune cells, contributing to its late and systemic accumulation in exper...
Background:
An accurate, non-invasive measure of return of spontaneous circulation (ROSC) is needed to improve management of cardiac arrest patients.
Objectives:
During a pulse check in Emergency Department (ED) cardiac arrest patients, we compared the correlation between 1) end tidal carbon dioxide (ETCO2) and systolic blood pressure (SBP), and...
Background
Oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), which is the ratio of VO2 to VCO2, are critical indicators of human metabolism. To seek a link between the patient’s metabolism and pathophysiology of critical illness, we investigated the correlation of these values with mortality in critical care...
Background:
Long-term follow-up for clinician-scientist training programs is sparse. We describe the outcomes of clinician-scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program.
Methods:
This was a cohort study of faculty clinician-scien...
Cardiac arrest (CA) produces global ischemia/reperfusion injury resulting in substantial multiorgan damage. There are limited efficacious therapies to save lives despite CA being such a lethal disease process. The small population of surviving patients suffer extensive brain damage that results in substantial morbidity. Mitochondrial dysfunction in...
Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition.
Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients...
Introduction:
Peripheral blood mononuclear cells (PBMCs) are commonly used to compare mitochondrial function in patients with versus without sepsis, but how these measurements in this mixed cell population vary by composition of immune cell subtypes is not known, especially in children. We determined the effect of changing immune cell composition...
Introduction: The American Heart Association recommends limiting chest compression interruptions to ≤10 seconds because prolonged interruptions are detrimental to survival in cardiac arrest. Determining the causes of interruptions is important to structure teams to minimize interruption time. This study sought to determine 1) whether performing mor...
Patients with coronavirus disease 2019 (COVID-19) can have increased risk of mortality shortly after intubation. The aim of this study is to develop a model using predictors of early mortality after intubation from COVID-19. A retrospective study of 1945 intubated patients with COVID-19 admitted to 12 Northwell hospitals in the greater New York Cit...
Traumatic peri-contusional penumbra represents crucial targets for therapeutic interventions after traumatic brain injury (TBI). Current resuscitative approaches may not adequately alleviate impaired cerebral microcirculation and, hence, compromise oxygen delivery to peri-contusional areas. Low-frequency oscillations in cerebral blood flow (CBF) ma...
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by spec...
Importance:
Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear.
Objective:
To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that r...
Introduction:
The purpose of this study was to validate and assess the performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) to predict seven-day mortality in US patients presenting to the emergency department (ED) with acute congestive heart failure (CHF) exacerbation.
Methods:
We performed a retrospective chart review on pati...
Introduction:
Our study aimed to determine 1) the association between time spent in the emergency department (ED) hallway and the development of delirium and 2) the hospital location of delirium development.
Methods:
This single-center, retrospective chart review included patients 18+ years old admitted to the hospital after presenting, without...
Traumatic peri-contusional penumbra represents crucial targets for therapeutic interventions after traumatic brain injury (TBI). Current resuscitative approaches may not adequately alleviate impaired cerebral microcirculation and, hence, compromise oxygen delivery to peri-contusional areas. Low-frequency oscillations in cerebral blood flow (CBF) ma...
Background
The prognostic important of Emergency Heart Failure Mortality Risk Grade (EHMRG) score in assessing short term mortality in Congestive Heart Failure (CHF) patients has been validated in the past, however, few studies have examined acuity patterns in the CHF population across healthcare settings. We aim to understand acuity patterns of CH...
Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that util...
Background:
Cervical vagus nerve stimulation (VNS) is a rapidly emerging bioelectronic treatment for brain, metabolic, cardiovascular and immune disorders. Its desired and off-target effects are mediated by different nerve fiber populations and knowledge of their engagement could guide calibration and monitoring of VNS therapies.
Objective:
/Hyp...
Importance
The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock.
Objective
To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock.
Design, Setting, and Participants
Randomized, blinded, multice...
PurposeTo study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest.
MethodsA prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystander-witnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergenc...
Background
While clinical characteristics and a range of mortality risk factors of COVID-19 patients have been reported, a practical early clinical survival calculator specialized for the unique cohort of patients has not yet been introduced. Such a tool would provide timely and valuable guidance in clinical care decision-making during this global...
For the clinical management of sepsis, antibody-based strategies have only been attempted to antagonize proinflammatory cytokines but not yet been tried to target harmless proteins that may interact with these pathogenic mediators. Here, we report an antibody strategy to intervene in the harmful interaction between tetranectin (TN) and a late-actin...
Increased detection of plasma lysophosphatidic acid (LPA) has been proposed as a potential diagnostic biomarker in ovarian cancer, but inconsistency exists in these reports. It has been shown that LPA can undergo an artificial increase during sample processing and analysis, which has not been accounted for in ovarian cancer research. The aim of thi...
We have recently reported an important role of Connexin 43 (Cx43) hemichannels in the pathogenesis of lethal sepsis through facilitating ATP efflux to potentiate the double-stranded RNA-activated protein kinase R (PKR)-dependent macrophage activation. Here we further elucidated the possible role of Pannexin 1 (Panx1) hemichannel in lethal sepsis by...
Abstract The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research fo...
Objective:
We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these...
Study objective:
We assess the productivity, outcomes, and experiences of participants in the National Institutes of Health/National Heart, Lung, and Blood Institute-funded K12 institutional research training programs in emergency care research.
Methods:
We used a mixed-methods study design to evaluate the 6 K12 programs, including 2 surveys, pa...
Studies of cardiac resuscitation initially alerted us to major disparities in survival between black and white Americans in the out-of-hospital cardiac arrest setting.¹,2 The disadvantage of black race was striking, and multiple possible factors were cited, including lower rates of bystander cardiopulmonary resuscitation (CPR),³ the effect of neigh...
It is estimated that a cardiac arrest occurs approximately every minute in the United States.¹ Beyond the mere return of spontaneous circulation (ROSC) and gross survival at discharge, good neurologic function with minimal disability is the goal for revived cardiac arrest patients. Partnering with the cardiology and emergency and critical care comm...
Dr. Becker has a relationship with Philips Medical Systems, National Institutes of Health, Zoll Medical Corporation, and Nihon Kohden. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Conducting a rigorous out-of-hospital study on patients in cardiac arrest is a daunting task. It requires training all members of the emergency medical system, randomization in the field (most commonly via a central physician-dispatcher), obtaining an exception to the typical requirement of informed consent, and rapidly administering a study drug i...
This Viewpoint introduces a newly released Institute of Medicine report describing many actions that stakeholders across the United States can take to improve outcomes from cardiac arrest.
Maximizing survival and minimizing disability are fundamental goals of patient care, but a new Institute of Medicine (IOM) report released this month, “Strategi...
The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives....
