Nadkarni, Vinay
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Publication Persistently Altered Brain Mitochondrial Bioenergetics After Apparently Successful Resuscitation From Cardiac Arrest(2015-09-14) Kilbaugh, Todd; Sutton, Robert M; Karlsson, Michael; Hansson, Magnus J; Nadkarni, Vinay; Naim, Maryam Y; Becker, Lance; Morgan, Ryan W; Margulies, Susan S; Bratinov, George; Lampe, Joshua Willard; Berg, Robert ABackground Although advances in cardiopulmonary resuscitation have improved survival from cardiac arrest (CA), neurologic injury persists and impaired mitochondrial bioenergetics may be critical for targeted neuroresuscitation. The authors sought to determine if excellent cardiopulmonary resuscitation and postresuscitation care and good traditional survival rates result in persistently disordered cerebral mitochondrial bioenergetics in a porcine pediatric model of asphyxia‐associated ventricular fibrillation CA. Methods and Results After 7 minutes of asphyxia, followed by ventricular fibrillation, 5 female 1‐month‐old swine (4 sham) received blood pressure–targeted care: titration of compression depth to systolic blood pressure of 90 mm Hg and vasopressor administration to a coronary perfusion pressure >20 mm Hg. All animals received protocol‐based vasopressor support after return of spontaneous circulation for 4 hours before they were killed. The primary outcome was integrated mitochondrial electron transport system (ETS) function. CA animals displayed significantly decreased maximal, coupled oxidative phosphorylating respiration (OXPHOSCI+CII) in cortex (PPPPCI PCII PCIPCII PCI+CII), as well as a 30% reduction in citrate synthase activity (P<0.04). Conclusions Mitochondria in both the cortex and hippocampus displayed significant alterations in respiratory function after CA despite excellent cardiopulmonary resuscitation and postresuscitation care in asphyxia‐associated ventricular fibrillation CA. Analysis of integrated ETS function identifies mitochondrial bioenergetic failure as a target for goal‐directed neuroresuscitation after CA. IACUC Protocol: IAC 13‐001023.Publication Collaborative SCA Survival Project: Cardiac Arrest Survival is a Mess(2009-02-01) Starr, Larry M; Pourdehnad, John; Braslow, Allan; Poliafico, Frank; Abella, Benjamin; Nadkarni, Vinay; Becker, Lance; Merchant, Raina; Brennan, RobertSystems diagnoses have been effectively used to understand many complex organizational systems within healthcare, government, military, and global corporate enterprises. Systems methodologies have been effectively used to change the direction and improve the outcomes of complex organizational systems. We feel that framing cardiac arrest survival as a systems problem and applying a systems methodology is innovative, practical, and essential if we are to make significant and sustainable impact.Publication Training Hospital Providers in Basic CPR Skills in Botswana: Acquisition, Retention and Impact of Novel Training Techniques(2012-12-01) Meaney, Peter A; Sutton, Robert M; Tsima, Billy M; Steenhoff, Andrew P; Niles, Dana E; Irving, Sharon Y; Shilkofski, Nicole; Boulet, John R; Nadkarni, Vinay; Davis, Amanda; Kestler, Andrew M; Church, Kasey K; Mazhani, LoetoObjective Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6 months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p < 0.01; adult 28% vs. 48%, p < 0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p < 0.01) and 6 months (38% vs. 67%, p < 0.01), and adult CPR skills were retained to 3 months (34% vs. 51%, p = 0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction.