Critical Care & Resuscitation Research Program

Led by Sam Parnia, MD, PhD, Director of Resuscitation Research at NYU Langone, the Critical Care and Resuscitation Research Program is dedicated to developing enhanced standards of resuscitative care to mitigate morbidity and mortality associated with cardiac arrest and critical illness. We are the first research center in New York state to take a holistic approach to patient-centered care, focusing not only on the implementation of novel resuscitative interventions, but also on understanding the cognitive and psychological experiences of critically ill patients. Our greatest strength lies in our international network of multidisciplinary collaborators who work tirelessly to collect valuable data in the field, and transform our findings into enhanced standard practices for clinicians worldwide.

Visit the Parnia Lab for more in-depth information about our research initiatives. Our group is actively working on several exciting projects in a number of areas.

Identification of Real-Time Non-Invasive Methods to Detect the Quality of Brain Resuscitation

These initiatives focus on developing cerebral oximetry and end-tidal carbon dioxide targets, modified EEG technologies, and a predictive multivariate model of cardiac arrest survivorship.

Physiological-Feedback Guided Cardiopulmonary Resuscitation (CPR)

We have pioneered the use of regional cerebral oximetry monitoring to detect the amount of oxygen being delivered to the brain in real-time during cardiac arrest. This technology can be used to complement current resuscitation quality metrics such as end tidal carbon dioxide, which measures the quality of circulation but cannot adequately assess vital organ oxygen delivery. Although we know that higher cerebral oxygen delivery and end tidal carbon dioxide are association with better patient outcomes, we are now looking to identify specific cerebral oximetry and end tidal carbon dioxide targets to predict optimal patient recovery. We propose to use this data to develop physiological targets that clinicians can use in real-time during CPR to guide their interventions.

Electroencephalography (EEG) Monitoring During Cardiac Arrest

We are among the first research centers in the world to implement EEG monitoring during CPR. Despite the fact that many cardiac arrest patients suffer considerable psychological, cognitive, and neurological consequences, presently, there are no standard methods to monitor brain activity during cardiac arrest. EEG provides a window into the brain so that clinicians may better understand the severity of their patient’s illness, and can better assess the impact of their interventions. However, implementing current EEG technologies in real-time during cardiac arrest is challenging, not only because it requires expert electrophysiologists to interpret outputs, but also because it requires total stillness of the patient so as to avoid artifact. We are working with a multidisciplinary team of collaborators to develop modified EEG technologies and monitoring methods to promote user-friendly, easily interpretable brain monitoring methods in the cardiac arrest setting.

Multivariate Model to Predict Cardiac Arrest Survival

Through a number of ongoing and previously completed studies, we have collected tens of millions of data points related to cardiac arrest resuscitation including demographic, physiological, medical, and interventional metrics. We now plan to use this data to develop a predictive multivariate model of cardiac arrest survivorship, with the ultimate goal of providing clear standards by which clinicians can gauge treatment options and provide optimal care.

Methods to Augment Oxygen Delivery and Improve the Quality of Brain Resuscitation During CPR and in the 24- to 48-Hour Post-Resuscitation Period

In these projects, we assess oxygen delivery through natural and synthetic blood products, the impact of mechanical CPR during in-hospital cardiac arrest, brain injury post-cardiac arrest, and the utility of extra-corporeal membrane oxygenation during CPR.

Augmenting Oxygen Delivery Through Blood Products

As cardiac arrest patients suffer severe injury due to lack of adequate blood flow and tissue oxygenation, it is essential that we develop methods of improving oxygen delivery in the early phases of CPR. As it has been shown that low levels of hemoglobin are associated with poorer cardiac arrest outcomes, we are actively beginning trials to assess whether transfusion of blood products during cardiac arrest may improve oxygen delivery and thereby improve patient outcomes. We are proposing a number of different interventions, some including natural blood products, and others including synthetic blood products that have been approved for human use.

Assessing the Impact of Mechanical CPR in In-Hospital Cardiac Arrest Patients

Clinician fatigue provides a major hurdle to delivering chest compressions at adequate rates and depths. Without adequate chest compressions, patient outcomes are expected to be poor. Mechanical CPR devices allow for automated compression delivery at fixed depths and rates, preventing provider fatigue and allowing clinicians who would typically be delivering compressions to focus on providing other interventions. We have previously shown that mechanical CPR improves oxygen delivery to the brain; however, additional information is needed to assess whether this intervention can improve patient survival and neurological outcome. In particular, studies are needed in the in-hospital cardiac arrest setting, where the intervention can be established early and the patient population is generally quite sick.

Protecting the Brain in Cardiac Arrest Survivors

As recent studies have indicated that the majority of brain injuries occur in the hours to days following initial cardiac arrest survival, we are working to develop interventions to protect the brain during this period. In particular, we are developing comprehensive drug interventions to target known pathways within the cascade of cardiac arrest-induced brain injury. We are among the first research groups to implement standardized post-cardiac arrest care together with targeted post-cardiac arrest interventions in an effort to improve patient outcomes.

Assessing the Impact of Extra-Corporeal Membrane Oxygenation (ECMO) in Cardiac Arrest Patients

Established as a lifesaving intervention in intensive care settings such as severe respiratory illness and shock, ECMO technology functions by removing carbon dioxide from the blood, and recirculating it back to the patient, thereby increasing oxygen content. Though its use in cardiac arrest patients remains underexplored, preliminary evidence suggests that ECMO may improve patient outcomes and enhance brain oxygen delivery during CPR. We have collected preliminary clinical data on a number of subjects who have undergone ECMO resuscitation at NYU Langone, and we now propose to conduct a largescale randomized control trial assessing its impact on survival and neurological outcome following cardiac arrest.

Understanding the Cognitive and Psychological Experiences Associated with Critical Illness and Death

These efforts focus on the link between brain oxygen delivery and conscious awareness during cardiac arrest—as well as cognitive and psychological impacts reported by cardiac arrest survivors.

Experiences of Awareness During Cardiac Arrest

We are currently conducting an observational study at 20 sites throughout the U.S. and Europe, which assesses the relationship between brain oxygen delivery and conscious awareness during cardiac arrest. Results from this study are expected to provide valuable information regarding the CPR- and patient-related factors that may impact different patient experiences related to consciousness and memory recall during periods in which the heart has stopped and the brain is seemingly not functioning. Additionally, it seeks to explore more holistically the psychological and cognitive impacts faced by cardiac arrest survivors.

We are also preparing to conduct a separate international study incorporating various quantitative and qualitative assessments regarding the psychological and cognitive experiences of cardiac arrest survivors.