early resuscitation                 

Early resuscitation aims to stabilize physiology and prevent secondary brain injury while definitive care is organized.

We tested a neuroprotective strategy with a randomized trial of inhaled nitric oxide in comatose survivors and were the top enrolling site in ICECAP, which evaluated the optimal duration of hypothermic temperature control after arrest; ancillary studies including POST-ICECAP and PRECICECAP extend this work by characterizing multidomain recovery and advancing precision care.

Recognizing that treatment effects are not uniform, our group has explored heterogeneity of treatment effect.  We developed and validated the Pittsburgh Cardiac Arrest Category (PCAC) to risk stratify patients within hours of return of spontaneous circulation, guiding early resuscitation and identifying treatment responders.  Building on this, we used both hypothesis-driven and unsupervised learning to define clinical phenotypes of post-arrest brain injury and organ failure.

A central focus of our work is improving care through precision monitoring. We evaluated both invasive and non-invasive neuromonitoring techniques to guide individualized treatment, and improve prognostication. We also led studies that developed automated CT-based methods to detect early signs of injury, described the evolution of neuromonitoring signals over time, and applied Bayesian models to improve early neurologic prognostication. Together, these studies advance patient-centered strategies by integrating imaging, physiologic, and computational tools into resuscitation science.

Recent Work

  • We linked CPR duration to distinct early brain injury phenotypes (benign coma, identical bursts, cerebral edema), suggesting duration aware pathways for early stratification and targeted monitoring.

  • Using a large single center cohort, we found that the sensitivity and false positive rates of gray–white ratio (GWR) on brain CT for predicting in hospital mortality and death by neurologic criteria vary with scan timing in the first hours post arrest, supporting time aware imaging.

  • Leveraging jugular venous oximetry and EEG, we showed how osmotherapy can improve cerebral oxygen extraction in well-defined clinical phenotypes, illustrating how multimodal monitoring can separate diffusion limited delivery from mitochondrial dysfunction.

  • We characterized the role and yield of brain CT after in hospital cardiac arrest, informing when and how imaging alters diagnosis and downstream care decisions.

  • We quantified the diagnostic yield of head to pelvis CT after non traumatic OHCA, finding clinically actionable causes and complications that inform early management while characterizing which patients benefit most from broad imaging.