Resuscitation Perspectives: Emergency Medicine Physician & Researcher

Code Blue events bring a new meaning to the concept of “a team effort.” When a code is called, a patient’s life is — quite literally — in the hands of the clinicians who respond. And to make matters more complex, code teams are often composed of clinicians from a variety of backgrounds and disciplines who may not routinely work together — except to collaborate on infrequent, unplanned, and high-stakes emergency events.

That’s the inspiration behind our Resuscitation Perspectives series, where we interview different members of Code Blue teams to better understand their role and impact in resuscitation response. And while our interviewees preferred to remain anonymous for privacy, we know their insights will resonate and inform readers across all Code Blue roles — from nurses and physicians to patients and families.

Resuscitation role spotlight: Emergency medicine physician & resuscitation researcher

So far in our Resuscitation Perspectives series, we’ve heard from voices in materials management, emergency medical services, and nursing. Our next interviewee brings a unique perspective as both an experienced emergency medicine physician and a researcher in cardiac arrest and resuscitation care.

Keep reading to learn more about the intersection between research and clinical work, the research our interviewee is most proud of, and why it can take time to change the way care is delivered to cardiac arrest patients.

Current role

What is your current role, and how are you involved with resuscitation/emergency response?

I’ve worked as an emergency medicine physician for nearly 20 years in a major hospital in Philadelphia, and I’ve been part of cardiac arrest and resuscitation care for the whole time.  I have a strong research interest in cardiac arrest and have been involved in a number of trials and other studies on the topic.

Fun fact: I got interested in cardiac arrest when I was a resident. I was covering the code pager, and we had a record number of codes in a 24-hour period with 8 cardiac arrests. By code number 5, the medical intensive care unit resident was like, “Can you stop this please?” We got return of spontaneous circulation back in 5 of those patients. That experience really got me thinking about how we manage codes and how we do cardiopulmonary resuscitation (CPR), and it was one of my inspirations to become a resuscitation researcher.

How do the unique responsibilities of your role impact your perspective on emergency response?

I find that my two roles — both cardiac resuscitation researcher and clinician — really impact each other. When I am doing research, I often think about my patients. I can visualize them and say, “I see this patient in this situation, and I want to understand how we can do better for them.” And as a clinician seeing patients with cardiac arrest, I think a lot about the studies, what the research shows, and what we’re working on.

There’s a really nice synergy between the two, and it’s one of the things that is a driving passion of mine: The research inspires the patient care, and the patient care inspires the research.

Impact on emergency response

Tell us a bit more about your research and its impact on resuscitation response.

A lot of my early work focused on CPR quality, its metrics, and defining approaches to using CPR quality to improve subsequent care. Much of that work was incorporated into the guidelines. I’m proud to say that a portion of the focus on CPR quality in its current form came from my work.

More recently, studies are showing that there’s a major disparity between men and women receiving CPR. That has led to more attention from the American Heart Association on that disparity and on providing resuscitation to women at the same rates as men. A product was even created — that I had nothing to do with but was inspired by our work — called the “Womanikin.” It’s basically a breast and bra enhancement to the standard manikin so that people can train for CPR on the female form. The theory is that women receive less CPR in part because people are used to training on male manikins. They’re uncomfortable and don’t know where to place their hands with female anatomy. I am proud to say my work has impacted that as well.

Do you see your role as having an impact on improving patients’ survival?

Yes. One of the things that gets me out of bed every day is knowing that people are having cardiac arrests. I am hopeful that I have a hand in changing that or affecting them positively in some way.

When I give lectures, I always make sure that they’re very practical and very applicable. I often will say to the audience: “My goal is that if you hear this lecture and there is a cardiac arrest tomorrow on your shift, you might do something a little bit different to improve your ability to save a life.” If the audience feels that way at the end of the lecture, then I’ve done my job.

Reflecting on the past — and looking to the future — of resuscitation response

What is some advice you would give your younger self that you didn’t know then, but know now?

I think I would have told my younger self just how long of a slog it is to change the way care is delivered for cardiac arrest victims. I think many people go into the field — and maybe it’s good they’re a little naive about this — thinking, “Oh, if we do a study and it shows something, then it’s going to effect change.”

But cardiac arrest is a very complicated challenge in that it involves bystanders, policy, emergency medical services, and hospital care. There are so many stakeholders and so many components that it’s devilishly hard to improve care. On the other hand, maybe it’s good I didn’t know that — I might have studied hypertension instead!

How do you see resuscitation response changing in the future?

There’s so much, but I think there will be advances in the ways that automated external defibrillators (AEDs) are used in the community. There’s more and more interest in wearable sensors, so I think we are going to have early notification of cardiac arrest that can either go to AEDs in the geographic area or even notify 911 directly. Many cardiac arrests are unwitnessed, so if someone’s wearing an alarm or device that can signal a cardiac arrest, that will be a real game changer for responses.

I think we will also see more use of extracorporeal membrane oxygenation (ECMO) for cardiac arrest response. There’s increasing data showing that we can save people in refractory ventricular fibrillation using ECMO, so I think for select centers and select cases, ECMO is going to be a big growing thing in resuscitation as well.