Joining just a handful of other institutions in the United States, investigators from Weill Cornell Medicine, Cornell University, and SUNY Upstate have established a multidisciplinary, translational Resuscitation Science laboratory to study human cardiac arrest and Cardiopulmonary Resuscitation (CPR).
Cardiac arrest is the abrupt cessation of cardiac activity that quickly leads to a complete loss of blood flow and represents a leading cause of death in the U.S. and worldwide. Only one out of six patients suffering cardiac arrest survive and many of them experience life-altering neurologic injuries, suggesting the critical need to seek innovative strategies to improve resuscitation outcomes.
In contrast to the traditional “one-size-fits-all” approach employed to treat patients in cardiac arrest, the innovative vision of Cornell’s researchers proposes an individualized medicine model where resuscitation care is grounded in the measurement of each patient’s physiology and where the therapies can be tailored to the individual patient’s needs and their response to treatment.
Translational science in resuscitation involves taking scientific discoveries from the laboratory or clinical research and turning them into practical treatments that can save lives in cardiac arrest. This process includes understanding the mechanisms of new CPR therapies and testing these new approaches in real-world settings, ensuring their safety and effectiveness.
Using a pig model, the group is investigating various cutting-edge technologies potential to improve the effectiveness of CPR and ultimately lead to better outcomes. Using transesophageal echocardiography (TEE), a modality that allows visualizing the heart in real-time during resuscitation and supporting the animals with extracorporeal membrane oxygenation (ECMO), their current work focuses on the study of the physiologic effects of chest compressions and different ventilation strategies and their impact in survival of cardiac arrest patients, and seeks to better understand heart-lung interactions when ECMO oxygenates blood outside of the body and pumps it back in during cardiac arrest. While the immediate focus is on translating this knowledge to human medicine, these discoveries have the potential also to improve outcomes in veterinary species suffering cardiac arrest.
The lab is led by multidisciplinary team of scientists from Veterinary Medicine, Emergency Medicine, and Critical Care, that includes Joaquin Araos, DVM, PhD, veterinary anesthesiologist and leading scientist in cardiopulmonary research with expertise in ECMO and heart-lung interactions; Felipe Teran, M.D., MSCE, emergency medicine physician and NIH-funded cardiac arrest scientist from Weill Cornell Medicine with expertise in echocardiography, TEE, and CPR physiology; Clark Owyang, M.D, emergency and critical care medicine physician and cardiac arrest scientist with expertise in heart-lung physiology and its implications in the use of ECMO and extra-corporeal life support (ECLS); and Manuel Martin Flores, DVM, a veterinary anesthesiologist with extensive experience in large animal research and expertise in advanced cardiovascular monitoring techniques and mechanical ventilation.
Following its successful start two years ago with grant funding from Cornell’s Office of Academic Integration, the Zoll Foundation, and the NIH, the lab has recently recruited Joshua Satalin, a highly skilled scientist and laboratory manager, and Professor Gary Nieman, pulmonary physiologist and leading expert in acute lung injury research, both with extensive experience in large animal cardiopulmonary research from the Cardiopulmonary Research Laboratory at SUNY Upstate. With the long-term goal to expand their work to pediatric cardiac arrest, the lab has recently recruited Robert Finkelstein, M.D., a pediatric emergency and critical care physician from Weill Cornell Medicine.
“Our partnership with the physicians and researchers at Weill Cornell Medicine is a source of immense pride for the faculty in the Department of Clinical Sciences at the College of Veterinary Medicine (CVM). The ongoing work within our Lab strengthens this alliance, benefiting critically ill patients in both human and veterinary medicine,” said Dr. Tim Hackett, Alexander de Lahunta Chair, Department of Clinical Sciences Professor, Emergency and Critical Care Medicine.
“We are taking a bench-to-bedside and back approach, also known as ‘bidirectional translational science model’. Our clinical experience at the bedside caring for critically ill patients helps us design laboratory experiments that can answer clinically relevant questions and ultimately improve patient outcomes. Our animal lab science directly informs our clinical research and impacts our patient’s care. Our observations in cardiac arrest patients are then further optimized by testing these hypotheses back in the lab,” said Dr. Teran.
"As Chair of Emergency Medicine at Weill Cornell Medicine, I am incredibly proud of our multidisciplinary Translational Resuscitation Science Laboratory, which represents a unique, world-class team of scientists dedicated to transforming emergency care. Their groundbreaking research perfectly aligns with our Department's mission and vision to advance patient care through excellence and innovation. This bold project embodies our commitment to pushing the boundaries of medical science to deliver life-saving discoveries and improve outcomes for patients in critical emergencies," added Rahul Sharma, M.D., MBA, FACEP.
TEE-Guided Resuscitation and ECMO Experimentation in Cardiac Arrest
During the first two years of experiments, the team established a clinically relevant model of cardiac arrest that involves inducing Ventricular Fibrillation, a common arrhythmia caused by Coronary Artery Disease. This model involved delivering sequential phases of resuscitation that replicate what patients receive during cardiac arrest, including CPR, mechanical ventilation, defibrillation, and administration of drugs such as epinephrine, and used TEE to show ultrasound-guided CPR has potential to outperform guideline-directed CPR; the physiologic advantage of TEE-guided CPR was then published in a leading critical care journal.
This year, the team expanded on the science by implementing a model of cardiac arrest supported by ECMO. In the right patient, cardiac arrest supported by ECMO has the potential to improve survival and neurological outcomes compared to traditional CPR significantly. By placing their pig model cardiac arrest on ECMO, the team is looking to improve the standards of care in how patients are resuscitated in the first minutes to hours of cardiac arrest when advanced mechanical circulatory support is an option.
“What we learn from the lab impacts the way we resuscitate people moving forward. Because we’ve been able to see the results of cardiac arrest resuscitation and ECMO in the controlled setting of an animal model, we can change team performance and improve patient outcomes immediately in the hospital setting when stakes are high,” said Dr. Owyang.
Why It Matters
From the institutional and research points of view, this strategic collaboration lays the foundation for building a long-term sustainable multidisciplinary Resuscitation Science Translational Research Center.
“Our physicians and scientists are engaged in world-class clinical care, cutting-edge research, and medical education that connect patients to the latest treatments and prevention strategies. It’s exciting to have Weill Cornell Medicine and Cornell University’s College of Veterinary Medicine come together to foster original research, mentorship, and teaching, which perfectly epitomizes the three pillars of Weill Cornell Medicine’s mission to Care, Discover, and Teach,” said Hugh Hemmings, M.D., PhD, Senior Associate Dean for Research and Chair of Anesthesiology at Weill Cornell Medicine.
From the patient’s perspective, however, this work can mean the difference between surviving or succumbing to a cardiac event. “To care for cardiac arrest patients one week, then take those observations to the lab to test physiologic principles the next is a huge privilege directly impacting patients’ lives,” Dr. Teran said.
