Project Leader:  Dr. Bernard Laughlin | University of Alaska Fairbanks

Abstract

The proposed supplement will be used to acquire training, practical experience and knowledge to bolster Dr. Laughlin’s research capacity and professional development with the goal of becoming an independent and leading investigator towards reducing health disparities in cardiovascular and cerebrovascular disease in rural Alaska by improving outcomes. Nationally, stroke and cardiac arrest are the leading causes of death and adult disability according to a report from the American Heart Association . In an article in by Ayala Veazie the second most common cause of death and disability in Alaska and rural Alaska is heart disease. Targeted temperature management (TTM) is the final link in the chain of survival for out of hospital cardiac arrest. This intervention reduces neurological injury and improves survival rates, but is not without complications which include shivering and hypotension. (Bernard SA, Gray TW, Buist MD, Jones BM Gutteridge G, et al.) It is also one example of an innovation in patient care that is not accessible to rural Alaska.

Specific Aims

The objective of this application are to accomplish the following aims:

  1. Define the role of peripheral A1 adenosine receptors in hypotension during CHA-assisted TTM.
  2. Define safety and efficacy of CHA-assisted TTM in swine.
  3. If our pilot project is funded Aim 3 will be to characterize the perspectives of Alaska-based emergency medical service (EMS) directors regarding how TTM might be optimized for prehospital care of cardiac arrest patients across rural Alaska.

Aim 1 will be accomplished with an experimental design by measuring blood pressure in CHA cooled rats by co-administering an A1 adenosine antagonist that does not cross the blood brain barrier. Aim 2 will be accomplished by collaborating with Dr. Asger Granfeldt, MD, DMSci and Dr. Rasmus Søndergaard Aagaard, MD at Aarhus Hospital in Aarhus, Denmark. Both physicians have significant experience conducting swine translational models of cardiac arrest and hypothermia as an intervention. Aim 3 will be accomplished by conducting qualitative, in-depth, semistructured interviews with Alaskan-based EMS directors.

Dr. Laughlin’s training plan objectives are: 1) to provide training in cardiovascular disease and stroke research with an emphasis on health disparities and translating aspects of hibernation to therapeutic hypothermia for cardiac arrest and stroke; 2) to provide training in skills necessary to successfully compete for independent NIH research grants; and 3) to provide training in research integrity and compliance.

Training will emphasize the following themes: fundamentals of experimental design, dissemination of research, funding and securing research, and on being a scientist. This research and career development experience will foster the capacity of Dr. Laughlin in the following ways by providing: 1) experience with basic preclinical testing including experimental design, data management, analysis and interpretation, statistics and manuscript preparation; 2) an introduction to an aspect of translational research that involves testing of safety and efficacy of novel drugs and formulation in more than one species; 3) exposure to qualitative and quantitative social science methods to analyze written and verbal responses from EMS directors.