Research Division Overview
Active Research Projects
National Emergency Airway Registry III
Asthma and Genetics
IRB# HS-05-00235
Principal Investigator: Sean O. Henderson, MD
Study Summary
Background: Bronchial asthma has been established as being the result of both genetic and environmental factors. Genetic variation also appears to play a role in response to therapy for asthmatics. One such therapeutic target, the β2-adenoreceptor (β2AR), has two such variants (β2AR A(46)G and β2AR C(79)G) which have been described to effect response to therapy.
Objective: In the emergency department (ED), we wished to examine the effect of these polymorphisms in asthmatics with regards to their response to standard therapy measured by change in Forced Expiratory Volume (one second) (FEV1). Our hypothesis was that polymorphisms in the β2AR gene would predict clinical response to therapy.
Methods: After consent, baseline data was obtained which included FEV1. Patients received standard care (albuterol and steroids). FEV1 was measured after each treatment. Blood was taken and processed to obtain the buffy coat, which was used in DNA extraction. Genotyping was done using the Taqman assay.
Inclusion Criteria: 18 - 54 years old, History of Asthma, Pulse Oximetry on arrival to ED ≥ 92%, Signs and symptoms consistent with acute asthma exacerbation including but not limited to dyspnea, hypoxia, wheezing, etc
Exclusion Criteria: Allergy to Albuterol, Has CHF, TB or pneumonia, Presence of fever > 100o F, Not able to give informed consent, Pregnant, Jail Patient
Impact of New CPR/Advanced Cardiac Life Support Guidelines on Outcome from Out of Hospital Cardiac Arrest
IRB# HS-09-00314
Principal Investigator: Marc Eckstein, MD MPH
Background: Despite compelling literature showing that paramedic transport of patients with out-of-hospital cardiac arrest (OOHCA) who fail to achieve return of spontaneous circulation (ROSC) is futile, many systems continue to routinely employ this practice. We implemented policies calling for 2 minutes of CPR by first responders prior to use of an AED; emphasis on continuous, uninterrupted chest compressions; provision of a minimum of 20 minutes of advanced life support efforts on scene prior to transport; avoiding hyperventilation; and minimizing transport of patients who failed to achieve return of spontaneous circulation (ROSC).
Study Objective: To determine the impact of these new CPR/ Advanced Cardiac Life Support (ACLS) guidelines intended to maximize resuscitation rates for patients with OOHCA while minimizing the frequency of transport for futile patients.
Methods: This is a retrospective, observational cohort study conducted in a large, urban, fire-based EMS system comparing all adult patients with non-traumatic bystander-witnessed OOHCA on whom resuscitative efforts were initiated by EMS during 2007 with those from 2000. The primary endpoint is neurologically intact survival to hospital discharge. All patients with EMS-witnessed collapse are excluded. All adult patients with non-traumatic bystander-witnessed OOHCA on whom resuscitative efforts were initiated by paramedics in the City of Los Angeles during 2007 and who had ROSC in the field are included. Hospital records for each of these patients will be reviewed to determine survival rates, and for those patients who survived, the neurologic status will be captured. These results will be compared to the same data compiled in 2000 with the same methodology which was published in 2005. Once the outcome data is obtained from review of hospital records, all patient identifiers will be deleted from the secure study database. IRB approval will be obtained from each receiving hospital in order to access patient records after IRB approval is granted by USC.
National Emergency Airway Registry III (NEAR III)
IRB# HS-07-00024
Site Principal Investigator: Sean O. Henderson, MD
Study Summary
This study, National Emergency Airway Registry, is intended to create a permanent international data repository of emergency airway management. This study is therefore an observational data collection study that will not affect the choice or timing of airway management. Rather, data recorded will only be comprised of clinical parameters associated with emergency department airway management. All ranges of patients who were intubated will be included into the database in the hope that this large-scale data registry will allow the medical community at large to be informed regarding the standard of care in emergency airway management and that future studies on airway will be based on this large-scale database. ED physicians will complete a paper collection form shortly after emergency department intubation or surgical airways are completed. This data will remain anonymous in such a manner that subjects cannot be identified, directly or through identifies linked to the subjects. Data collection will be retrospective and observational. It will not interfere with the routine care of emergency patients. NEAR III is only a registry of clinical parameters associated with emergency department airway management.