In 50% of paramedic-treated cases of SCA, the heart is restarted and patients are taken to hospital. Of those admitted, 60% will die, most of brain death. Those that do survive and return home can face a spectrum of difficult neurocognitive and psychosocial challenges. Their families can suffer post-SCA stresses as well. There are also approximately 18,000 bystander SCA interventions each year in Canada. Post-traumatic stress among these lay-responder is high and there is little to no follow-up on their well-being.
Theme Projects
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Improving Neurological Outcomes after SCA
In 50% of EMS-treated sudden cardiac arrest cases, the heart is restarted and the patient is transferred to a hospital. Some are unstable and die in the emergency department. Of those who can be stabilized and admitted to hospital, more than half will die in hospital, most of brain death. To close this gap, our researchers are investigating:The clinical pathophysiology of globally ischemic brains: Hypoxic ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurologic disability in survivors. The pathophysiology of HIBI encompasses a heterogeneous cascade that culminates in secondary brain injury and neuronal cell death. This begins with primary injury to the brain caused by the immediate cessation of cerebral blood flow following CA. Thereafter, the secondary injury of HIBI takes place in the hours and days following the initial CA and reperfusion. Among factors that may be implicated in this secondary injury include reperfusion injury, microcirculatory dysfunction, impaired cerebral autoregulation, hypoxemia, hyperoxia, hyperthermia, fluctuations in arterial carbon dioxide, and concomitant anemia. Clarifying the underlying pathophysiology of HIBI is imperative and has been the focus of considerable research to identify therapeutic targets. Neuroprotection of the brain during ischemia and reperfusion: the value of NA-1, a neuroprotective drug currently undergoing clinical evaluation in stroke in the FRONTIER trial for post-cardiac arrest global ischemia in whole animal models. The bioscience of overall global ischemic insult of the brain after CPR and the investigation of potential therapies for global brain ischemia at the cellular level.
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Improving Quality of Life For Survivors, Families and Lay-Responders
Two-thirds of cardiac arrest survivors suffer from cognitive deficits, particularly memory, planning, problem-solving, and attention, two-thirds experience anxiety and depression, one-third develop post-traumatic stress symptoms, and only half of them ever return to work. The family members of Sudden Cardiac Arrest survivors experience similar psycho-social disturbances leading to an overall reduction in quality of life. A lack of systematic patient-centered assessment and reliable resources for understanding the physical, cognitive, emotional, and social needs are not available. The absence of a coordinated plan to assess (short-term) and reassess (long-term) survivorship hampers a genuinely patient and family-centered approach to care. The recently published American Heart Association Scientific Statement on Survivorship makes a direct call for attention to the quality of life and survivorship, acknowledging the complex emotional, physical, social, and economic challenges associated with life during and after cardiac arrest. This statement also signals the need to move from the language of survival to a discourse of recovery. Bystander intervention is a critical first line of response to a sudden cardiac arrest. There are 18,000 bystander interventions a year in Canada and not automatically visible is the high risk of post-traumatic stress. Developing programs to support Bystander care after a SCA is crucial for public health.