The new ECPR Alert prehospital life support protocol being tested at The Ohio State University Wexner Medical Center in conjunction with the Columbus (OH) Division of Fire has been credited with saving lives. According to Dr. Ernest Mazzaferri Jr., medical director of The Ohio State University Richard M. Ross Heart Hospital, “This protocol is for people who are in ventricular fibrillation or refractory ventricular tachycardia, which are irregular heart rhythms that aren’t compatible with life and resist being shocked back to normal.” He explains that if these patients do not respond to being shocked, they would die in the field because there are no options to save them. Now, he adds, “In certain situations, we have had patients survive and walk out of the hospital.”
In the field, Columbus EMS personnel follow their protocol for ventricular fibrillation. If after three defibrillation attempts, the patient’s heart rhythm remains unchanged, the medics call an ECPR Alert to Ohio State Wexner Medical Center; place a mechanical CPR device on the patient; and transport the patient straight to the cardiac catheterization lab, where a medical team is waiting.
In the lab, the patient is put on extracorporeal membrane oxygenation (ECMO), which takes over the functions of the heart and lungs and allows the heart and lungs to rest while the doctors identify the problem and get the heart restarted and beating well, according to Dr. Bryan Whitson, a cardiothoracic surgeon who leads the ECMO program at Ohio State.
“Patients have a chance to walk out of a hospital with neurological recovery and have a meaningful life when, essentially, they very likely would have died,” notes Dr. Konstantinos Dean Boudoulas, an interventional cardiologist and one of the physicians leading the protocol.
The ECPR protocol has been tested in only a few small studies recently; so far, the limited data show an increase of about a 40 percent chance of survival, according to the Medical Center. The research team is hopeful that this protocol will be more widely adopted in the prehospital care arena (
A study that recently appeared in the European Journal of Preventive Cardiology suggests that rapid increases in pollution may be as harmful to the heart as sustained high levels. 1 The study was conducted in Jena, Germany, a city with 100,000 residents that had only a few days over the past several years during which concentrations of some air pollutants exceeded European Union (EU) daily limits. All patients living within 10 km of Jena who had a heart attack and were admitted to Jena University Hospital between 2003 and 2010 were included. Each of the 693 patients served as his or her own control. Concentrations of air pollutants one, two, and three days before heart attack symptoms were compared to concentrations in the previous and following week. The researchers analyzed whether there were rapid variations in air pollution before the heart attack. Increases of nitric oxides of more than 20 μg/m3 within 24 hours were associated with a more than doubled risk of heart attack.
This study is noteworthy because it investigated whether rapid increases in pollution increase the risk of heart attack independently of an absolute threshold. In addition, it sought to ascertain whether there could be an association between heart attacks and changes in air pollution even in clean air cities where although concentrations of air pollution vary, they do not exceed EU limits.
Senior author Dr. Florian Rakers, a researcher and doctor at Jena University Hospital, explains: “Our study suggests that the risk of heart attack associated with nitrogen oxides depends on the dynamics and extent of increases, and not only on exposure to high concentrations.” The researchers were surprised by the magnitude of the association. Dr. Rakers said: “The risk of heart attack more than doubled after a 24-hour increase in nitric oxides of more than 20 μg/m3 [microgram per cubic meter of chemical vapors, fumes, or dust in the ambient air]. The impact of rapid increases in air pollutants on heart health may be at least as important as absolute concentrations.”
He continued: “The adverse effects of rapid rises in pollution can occur in smaller cities. Increases of nitric oxides by more than 20 μg/m3 within 24 hours happen more than 30 times per year in Jena, which is known as a ‘clean air’ city where statutory limits for nitric oxides are generally not violated.” He concluded that when these findings are replicated, the EU should discuss statutory limits on rapid increases of nitric oxides. He noted that efforts to reduce these air pollutants might even mean banning diesel cars that exceed EU emission limits. Ground traffic and especially diesel cars are the primary source of nitric oxides in the EU.
1. Rasche M, et al. Rapid increases in nitrogen oxides are associated with acute myocardial infarction: A case-crossover study. European Journal of Preventive Cardiology. 2018. DOI:10.1177/2047487318755804; e-mail: firstname.lastname@example.org.
Vanderbilt Univ. wins DARPA’s RF Spectrum Challenge
In its quest for “a revolutionary solution to the century-old approach of allocating bands for specific use of the radio frequency (RF) spectrum,” the U.S. Defense Advanced Research Projects Agency (DARPA) launched Round 1 of its Spectrum Collaboration Challenge (SC2) in December. A team of Vanderbilt University researchers and alumni (Team MarmotE) was the winner. Round 2 of the three-year Challenge will be held in December 2018.
The Vanderbilt team includes Peter Volgyesi, a research scientist, and Miklos Maroti, a research associate professor at Vanderbilt’s Institute for Software Integrated Systems. Competitors included defense contractors, private companies, and other academic groups in mobile networking globally, including BAE Systems, which came in second; Grumman, which placed eighth; and university teams from Berkeley, Purdue, Ghent and Antwerp, University of Florida, Northeastern, and Texas A&M.
The teams faced fluctuating bandwidths and interference from other competitors as well as DARPA-designed bots that tested and challenged competitors’ radio designs. Each team’s radio performance was scored based on its collaborative spectrum sharing abilities.
The global demand for RF spectrum has escalated as more and more wireless technologies have been introduced and the military has gravitated to reliance on unmanned platforms from underwater sensors to satellites. DARPA is looking to resolving the RF spectrum scarcity problem using machine intelligence, which it considers the most efficient solution. Instead of the current policy of isolating wireless systems by dividing the spectrum into rigid licensed bands allocated over large, geographically defined regions, rationing access to the spectrum in exchange for the guarantee of interference-free communication and resulting in many allocated bands going unused by licensees while other bands are overwhelmed, RF Spectrum competitors will reimagine a new, more efficient wireless paradigm where radio networks automatically collaborate to determine how the spectrum should be used moment to moment, according to DARPA.
DARPA’s Paul Tilghman presided over the Spectrum Collaboration Challenge preliminary event in December, at Johns Hopkins University. In the Round 1 competition, two radio networks were asked to share the spectrum. The top performing teams successfully adapted their spectrum usage so that both networks could successfully transmit with minimal interference.
In Round 2, competitors will be challenged to enable three simultaneous wireless technologies to achieve full autonomous sharing of the spectrum, which is now difficult and will take a higher degree of agility and reasoning to achieve, according to DARPA. In addition, challengers will have to operate in an interference environment beyond that existing commercial and military radios can handle: The number of simultaneous wireless network types will be increased from three to five and the number of radios will be increased from five to 50. Additional information is available from Brenda Ellis, (615) 343-6314; Brenda.Ellis@Vanderbilt.edu.
Hudson County (NJ) supports stronger building codes
The Hudson County (NJ) Board of Freeholders recently endorsed New Jersey Assembly Bill 135 and Senate Bill 1261, which proposes installation of an automatic sprinkler system in accordance with National Fire Protection Association 13, Standard for the Installation of Sprinkler Systems; measuring the number of stories from the grade plane; using noncombustible materials for construction; and installing a fire barrier with a fire resistance rating of at least two hours that extends from the foundation to the roof.
“Local lawmakers are waking up to the harsh realization that using inadequate, combustible building materials is not the solution to affordable housing concerns. It’s apparent developers will continue to do the bare minimum when it comes to adherence to the building code, and as such, it’s vital the New Jersey legislature moves quickly to prevent another catastrophe,” says Kevin Lawlor, spokesperson for Build with Strength, a coalition of the National Ready Mixed Concrete Association consisting of community organizations, fire safety professionals, architects, engineers, and industry experts committed to strengthening the nation’s building codes.
This action follows similar resolutions adopted by other New Jersey counties and municipalities and was prompted by a number of fires that occurred in wood-frame apartment complexes in the state, including a fire in Princeton in December and massive fires in buildings constructed with combustible materials in Maplewood and Edgewater.