Clinical Research
Neurological Innovation Begins with Research
When it comes to heart and brain resuscitation after cardiac arrest, the leadership of University Hospitals goes back more than a century. UH has helped develop resuscitation techniques that have had a significant impact on neurological health, since successful cardiac resuscitation can prevent brain damage due to a lack of oxygen.
George Crile, MD, Chief of Surgery at Western Reserve University, was the first to successfully use external chest compression in 1903 and the first to use adrenaline (epinephrine) in resuscitation in 1909. Claude Beck, MD, professor of cardiothoracic surgery, performed the first successful human cardiac defibrillation in 1947. Dr. Beck also introduced the first CPR course for the lay public in 1958.
That tradition of innovation continues today with research and discovery at University Hospitals Neurological Institute’s Neurocritical Care Center.
Case Critical Care Bioinformatics Project
The ICU of the Future: Translating Data into Bedside Action
The Problem: Too Much Data. Not Enough Information
- Data Overload. In today’s ICU, there are staggering amounts of data, beyond the capability of any person to absorb, integrate and act upon reliably.
- Lack of Processing. Basic statistical analyses are elusive. More sophisticated analyses and correlations are unavailable at the bedside.
- Lack of Integration and Synchronization. Device interoperability is limited.
The Solution: the Integrated Medical Environment™ (tiME™)
- Synchronize, integrate, and process medical data from all sources
- Based on an open middleware architecture
- Facilitate device interoperability (“plug and play”)
- Allow clinicians to index, search, and assemble data
- Present all information in readily interpretable form.
Case Critical Care Bioinformatics Consortium
Established in 2007, the Case Critical Care Bioinformatics Consortium is a tight collaboration between physicians, engineers, and scientists focusing on integrating data acquisition across all devices in the ICU, transforming data to actionable information through signal processing, and providing clinical decision-support through innovative visualization at the bedside.
Our mission has been is to provide a forum for multidisciplinary collaboration between the computational sciences and critical care medicine. The result of this collaboration is the Integrated Medical Environment™ (tIME™) which we believe could lead to better insights into complex physiology, early detection of secondary insults, reduction in medical errors, improved efficiency, and most importantly, better patient outcomes. We believe that this approach could fundamentally change the way medicine is practiced.
Coma Recovery After Cardiac Arrest
Cardiac arrest is a significant health problem worldwide and carries a high rate of morbidity and mortality. With long-term neurologic and cognitive dysfunction a leading cause of disability in survivors, the physical, emotional, and financial burdens imposed on patients and families are great. While therapeutic hypothermia has been shown to improve neurologic and cognitive outcomes, little is known regarding the optimum deployment of this underutilized therapy to maximize recovery and minimized long-term cognitive dysfunction. This is due in part to a lack of real-time measures of neurologic recovery after cardiac arrest as a patient slowly emerges from coma to consciousness,
Vital interactions between the thalamus and cortex have been implicated in the maintenance of arousal and awareness. Additionally, some evidence points to a disruption of this thalamocortical activity as the mechanism of coma in hypoxic-ischemic encephalopathy,
Our objective is to study this thalamocortical desynchrony after cardiac arrest in order to better understand the mechanisms of coma recovery. Our experiments are conducted on well-established animal models of cardiac arrest. However, these techniques can be easily translated into future human studies. Neurophysiologic signals studied in the experiments include spikes, local field potentials (LFP), somatosensory evoked potentials (SSEP), and electroencephalogram (EEG) from both the cortex and thalamus. Using advanced signal processing techniques, we can garner important data to elucidate the interaction between these two key structures in the recovery to consciousness.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a non-invasive tool for the electrical stimulation of neural tissue. It is a most useful research technique that allows neurophysiological investigations from diverse perspectives. Single stimuli can depolarize neurons and induce measurable effects. Trains of stimuli modify excitability of the cerebral cortex at the stimulated site and also at remote areas along functional anatomical connections. Thereby, it has been extensively used in behavioral neuropsychology. More notably, TMS is a useful diagnostic and prognostic test. We will be soon utilizing this technique in specific projects in our patient population.