M-RISE on the Rise: One Year of Improving Outcomes in Out-of-Hospital Cardiac Arrest
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In 2014, Karen Grams of Ypsilanti suddenly went into cardiac arrest.
“I was sitting on the couch talking to my husband, who was in another room getting ready to go bowling. Then I went quiet, and he came in to check. If we hadn’t just been talking, he might not have found me.”
Karen remembers nothing of the event itself and relies on the accounts of family members like her husband, whose immediate 911 call and administration of bystander CPR likely saved her life.
To this day, neither Karen nor her doctors know why she suffered a cardiac arrest. She was physically active, healthy, and had no family history of heart conditions. Unusual as a case like Karen’s might seem, however, it is far from uncommon. The American Heart Association reports that more than 356,000 out-of-hospital cardiac arrests (OHCA) occur annually in the United States—nearly 90% of which are fatal. Among those who survive, the majority have some degree of brain injury resulting from impaired blood flow.
Seeking to improving outcomes in cardiac arrest cases like Karen’s, a new research program called M-RISE was formed in 2019. Housed at MCIRCC, the program focuses on discovering, translating, and implementing innovative therapies to prevent brain injury caused by out-of-hospital cardiac arrest. (You can read more about how MCIRCC helped make M-RISE a reality on our program overview page.) In recognition of Sudden Cardiac Arrest Awareness Month, MCIRCC followed up with M-RISE to learn more about the transformative work their teams—comprised of three core Projects and a Postdoctoral Training Program—have been accomplishing throughout the program’s first year.
Basic Science Project
The M-RISE Basic Science team is studying neuroprotective agents that can be given through the nose and muscles during a cardiac arrest. Their goal is to determine the lowest doses that achieve the maximum treatment effect when given during CPR, as well as how timing of the administration impacts its neuroprotective effects.
In its first year, the Basic Science team has been studying magnesium and insulin as possible neuroprotective therapies. The team’s clinical trial for insulin administration is following the protocol developed by the M-RISE Clinical Science team in order to best mirror what they envision will be clinical practice.
The Basic Science team has also been working with data from the Population Science Project. This data gives the team clearer insight into the potential of bystanders delivering these therapies, as well and what that sequence of events might look like in the real world. The Basic Science team is using these findings to coordinate its pre-clinical modeling to replicate the treatment conditions that could be achieved by bystanders or first responders.
Clinical Science Project
The M-RISE Clinical Science team is working with the U.S. Food and Drug Administration (FDA) to determine a regulatory pathway for a future trial involving bystanders and first responders administering intranasal neuroprotective agents to those suffering an out-of-hospital cardiac arrest. The team is also working with the Basic Science Project to use its pre-clinical data when developing an application for an investigational new drug.
The Clinical Science team’s first year has been focused around creating a clinical trial protocol for the study of safe dosing in healthy volunteers. This protocol is being used by the Basic Science Project as it carries out its pre-clinical testing and analysis of potential neuroprotective therapies. The development of this protocol is the first of four major aims the Clinical Science team will continue work on in the coming years:
How can we perform an acceptable trial of very early nasal insulin?
Can we design simple instructions for bystanders?
How much insulin can we safely administer through the nose?
How many victims of cardiac arrest will we need to include in a clinical trial in order to get a meaningful answer?
Population Science Project
The M-RISE Population Science Project is working to identify barriers and facilitators to shortening time to treatment during out-of-hospital cardiac arrest. The group is utilizing a learning health system approach to optimize time to CPR and defibrillation and will then use this infrastructure, along with simulation-based training and assessment, to inform implementation strategies for early intranasal and intramuscular therapies.
A patient who is experiencing a cardiac arrest is at risk of death within the first few minutes. Most often, those crucial few minutes involve 911 dispatch calls and first responders. Over the first year, the Population Science team has been reviewing dispatch calls and recording data from them. The team has begun to notice important trends, which it hopes to share with experts who can help make necessary changes to the system. After this, the team will test these changes using simulations and then measure improvements over time.
Another focal point of the Population Science Project’s first year has been its ongoing collaborations with the Washtenaw/Livingston Out-of-Hospital Cardiac Arrest Learning Community. This Learning Community permits open discussion of issues related to OHCA and sees regular engagement among bystanders, survivors, first responders, physicians, vendors, and policy makers. The team is also continuing its collaborations with the Seattle Strategically Focused Research Network (SFRN), and, building upon their work with the Seattle SFRN, submitted a grant to the Emergency Medicine Foundation with the aim of evaluating the impact of COVID-19 on 911 dispatch workflows and critical bystander care processes.
Postdoctoral Training Program
A cardiac arrest involves more than just the patient and their heart. M-RISE recognizes the complex system of events surrounding a cardiac arrest and is tackling the problem at every stage in the chain. This includes the training of a new generation of resuscitation scientists who will have a unique understanding of the entire translational spectrum involved in optimizing cardiac arrest outcomes.
Throughout the program’s first year, various recruitment efforts have been underway as the three M-RISE core projects prepare to accept training fellows. These efforts include developing program outreach materials, participating in recruitment events, and identifying and interviewing potential candidates.
Though the COVID-19 pandemic has affected travel the world over, M-RISE plans for its eventually incoming fellows to engage in a primary module of interest (Basic, Clinical, or Population Science) while also having interspersed immersion in each of the other areas in order for them to develop a comprehensive picture of resuscitation science.
Cardiac arrest is a major public health crisis affecting lives around the world. For Karen Grams, it is incredibly reassuring to know that programs like M-RISE exist, and to see first-hand all of the hard work and research going in to improving cardiac arrest outcomes. Karen herself is among the survivors participating in the OHCA Learning Community partnered with the M-RISE Population Science team. She says that sharing her story is her way of supporting other survivors and giving back to those who saved her life.
“I suppose that’s a silver lining to this whole experience—getting to meet so many wonderful people!”
- Karen Grams