In the project entitled "Precision Medicine Resuscitation: Novel Strategy for Real-Time Rhythm Identification and Vitality Assessment during CPR", we propose to test a precision medicine approach to advance our understanding of the pathophysiology and response to resuscitation care for patients with ventricular fibrillation sudden cardiac arrest (VF-SCA). Currently resuscitation is often practiced using a one-size-fits-all algorithm even though we appreciate that VF-SCA is characterized by a heterogeneous physiology that depends on patient, treatment, and time characteristics. Although heart rhythm assessment from the ECG has potential to guide therapy, accurate assessment in real-time is not possible because CPR produces artifact that obscures the ECG. Our group has used a unique data resource that links real-time digital recording of VF-SCA with a population-based clinical registry to develop human-engineered methods that "read-through" CPR artifact to accurately identify the rhythm and assess the rhythm's vitality as a means to gauge the patient's physiology and help inform care during CPR.We propose an innovative research plan that will advance our abilities to identify the ECG rhythm and assess its vitality during CPR and provide the basis to evaluate optimal approaches to implement precision resuscitation. 1. We will evaluate whether computer-engineered algorithms using artificial intelligence can provide a more predictive "read-through-CPR" algorithm of rhythm identification and rhythm vitality compared to human-engineered algorithms. 2. We will use the optimal read-through-CPR algorithm to investigate mechanisms of outcome disparity; specifically investigating pathways by which female sex confers survival advantage. 3. We will evaluate how the precision medicine algorithm may change care compared to current practice by applying the precision algorithm to real-time recordings of VF-SCA. 4. We will conduct a simulation randomized trial among EMTs to compare precision medicine to the current conventional algorithm to understand how the real-time dynamic prompts of a precision strategy may affect rescuer performance of quantitative CPR metrics. We anticipate the research will set the stage for interventional studies that robustly test the precision medicine approach. Ultimately precision resuscitation could enable the rescuer to align the choice, dose, and timing of therapy to the patient's pathophysiology, and in turn improve survival.
|Program type||Strategically Focused Research Network|
|Effective start/end date||07/01/2019 → 06/30/2023|