Children’s & Women’s Hospital joins multicenter study on cardiac arrest care for pediatric patients

Mukul Seghal, M.D.,MBA, an assistant professor of 

pediatrics, is principal investigator of the study.

With goals of saving more children who suffer from cardiac arrest and enhancing CPR protocols, USA Health Children’s & Women’s Hospital has joined a multicenter collaborative study that will assess up to 7,000 cardiac arrest cases at 100 hospitals.

More research is needed on the topic because current CPR guidelines are mostly based on adult data, leaving a gap in understanding how best to help kids during emergencies, said pediatric intensivist Mukul Sehgal, M.D., MBA, who will serve as the site principal investigator for the study in the pediatric intensive care unit (PICU) at Children’s & Women’s Hospital.

CPR stands for cardiopulmonary resuscitation, a method that can help save someone’s life during cardiac arrest, when the heart stops beating or beats too ineffectively to circulate blood to the brain and other vital organs, according to the American Heart Association. Sehgal is an assistant professor of pediatrics in the division of pediatric critical care at the Whiddon College of Medicine, where his duties include teaching physicians in training.

Cardiac arrests in children are a major public health issue with thousands of pediatric patients each year treated with CPR and managed after a cardiac arrest. Unfortunately, neurological outcomes following in-hospital CPR events can vary, and sometimes leave children with neurological deficits.

As part of the cardiac arrest project’s protocol, all attending physicians in the hospital’s PICU will undergo training by Children’s Hospital of Philadelphia team members for data assimilation and entry procedures.

Key goals for the multiyear study include:

• Assess CPR quality: Analyze how well CPR is performed in different hospitals.
• Link CPR to survival: Investigate how CPR techniques affect survival rates.
• Post-care matters: Examine how care after cardiac arrest impacts recovery.
• Monitor responses: Study how children's bodies respond to medications like epinephrine during CPR to find the best dosing strategies.

“The insights gained could also help save more lives in the future,” Sehgal said, “and improve outcomes for children experiencing cardiac arrests.”

Mbaka studies new tool for weaning patients from ventilator

Maryann Mbaka, M.D., an assistant professor of 

surgery, is leading the study at USA Health.

Research shows that patients whose breathing is supported by a ventilator for an extended time are at higher risk of losing strength in the diaphragm, the major muscle of respiration, and developing a life-threatening infection such as pneumonia.

Maryann Mbaka, M.D., a trauma and emergency general surgeon at USA Health University Hospital, is studying a new way to help these patients regain the strength they need to breathe on their own more quickly – potentially avoiding infection and death.

USA Health is one of 18 sites in the nation enrolling patients in the ReInvigorate Study, which will evaluate the safety and efficacy of the pdSTIM System to increase diaphragm strength and improve ventilation weaning for patients when compared with the standard of care.

“This research focuses on the stimulation of the phrenic nerve – which controls the diaphragm – as a way to wean critically ill patients off ventilatory support,” said Mbaka, who also serves as an assistant professor of surgery at the Whiddon College of Medicine. “Patients with acute respiratory failure can experience many complications associated with critical illness and prolonged hospitalization; therefore, having any means to improve the care of those patients and expedite ventilatory wean will not only improve the care of the patients, but also improve outcomes.”

Developed by Stimdia Medical for use at the bedside, the pdSTIM System is indicated for ventilated adults who have been on mechanical ventilation for at least 96 hours and have failed at least one weaning attempt. To employ the system, a provider inserts a temporary pacing lead into a small incision in the patient’s neck, and a nearby console recognizes the onset of the patient’s inhalation and stimulates the phrenic nerve through the lead, causing the diaphragm to contract.

Studies have estimated that more than 300,000 patients receive mechanical ventilation in the United States each year, according to the Centers for Disease Control and Prevention. Pneumonia, sepsis, acute respiratory distress syndrome, blood clots and fluid buildup in the lungs are among the complications that can occur in patients receiving mechanical ventilation.

Mortality in patients with acute lung injury on mechanical ventilation has been estimated to range from 24% in people ages 15 to 19 to 60% for patients ages 85 and older.

Mbaka said critically ill patients admitted to the intensive care unit at University Hospital who fail to wean from the ventilator per protocol will be evaluated for this study after appropriate consent is obtained.