A5064905913- Cardiac Arrest and Resuscitation
- Traumatic Brain Injury and Neurovascular Disturbances
- Mechanical Circulatory Support Devices
- Airway Management and Intubation Techniques
- Tracheal and airway disorders
- Non-Invasive Vital Sign Monitoring
- Mitochondrial Function and Pathology
- Cardiac Ischemia and Reperfusion
- Neonatal and fetal brain pathology
- Heart Rate Variability and Autonomic Control
- Alcoholism and Thiamine Deficiency
- Childhood Cancer Survivors' Quality of Life
- Obstructive Sleep Apnea Research
- Cardiac, Anesthesia and Surgical Outcomes
- Anesthesia and Pain Management
- Peripheral Neuropathies and Disorders
- Anesthesia and Neurotoxicity Research
- Voice and Speech Disorders
- Porphyrin Metabolism and Disorders
- Vascular Anomalies and Treatments
- Botulinum Toxin and Related Neurological Disorders
- Cardiovascular and Diving-Related Complications
- Cardiac electrophysiology and arrhythmias
- Plant-based Medicinal Research
- Acute Ischemic Stroke Management
Children's Hospital of Philadelphia
2018-2025
University of Pennsylvania
2021-2024
Philadelphia University
2023
Anna Needs Neuroblastoma Answers
2020
Hospital of the University of Pennsylvania
2015-2017
Traumatic brain injury (TBI) is one of the leading causes morbidity and mortality in children. While left ventricular systolic dysfunction (LVSD) has been observed following TBI adults, very little known regarding it pediatric population. The aim this study was to evaluate frequency admission risk factors for TBI. authors hypothesized that cardiac would be associated with mortality. This a single-center retrospective observational from quaternary children's hospital. Pediatric patients who...
Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim this study was to determine if differences exist between Black and White children with regard anesthetic analgesic medications for single procedure at our institution.We conducted retrospective review administered patients emergency appendectomies large academic children's hospital from 2010 2015. We examined the...
Background End-of-life care for a child is an emotionally charged experience pediatric trainees. Objectives Describe the progression of medical trainee experiences with end-of-life and determine personal/professional that facilitated integration experiences. Methods Medical students (MS4) residents (PL-1-3) completed 30-question survey about patient deaths these Results A total 307 404 (76%) participated. Mean number ranged from 3.0 to 6.5 in prior 12 months, most common location was...
Cerebral mitochondrial dysfunction is a key mediator of neurologic injury following cardiac arrest (CA) and regulated by the balance fusion fission (mitochondrial dynamics). Under stress, can decrease mass signal apoptosis, while promotes oxidative phosphorylation efficiency. This study evaluates dynamics content in brain tissue 24 h after CA between two cardiopulmonary resuscitation (CPR) strategies.Piglets (1 month), previously randomized to three groups: (1) Std-CPR (n = 5); (2) HD-CPR 5;...
AffiliationsHospital of the University Pennsylvania Philadelphia, PAJohns Hopkins Bloomberg School Public Health Baltimore, MDJohns MD
We present preliminary measurements of the change in oxidized cytochrome c oxidase concentration cerebral tissue during asphyxia and cardiopulmonary resuscitation a pediatric swine model asphyxia-associated cardiac arrest.
Swine exhibit cerebral cortex mitochondrial dysfunction and neuropathologic injury after hypoxic cardiac arrest treated with hemodynamic-directed CPR (HD-CPR) despite normal Cerebral Performance Category scores. We analyzed the temporal evolution of plasma protein biomarkers brain inflammatory cytokines, as well cortical neuropathology for five days following pediatric asphyxia-associated HD-CPR.
Abstract Objective. Amplitude Spectrum Area (AMSA) of the electrocardiogram (ECG) waveform during ventricular fibrillation (VF) has shown promise as a predictor defibrillation success cardiopulmonary resuscitation (CPR). However, AMSA relies on magnitude ECG waveform, raising concerns about reproducibility across different settings that may introduce bias. This study aimed to evaluate normalization approaches and their impact removing bias while preserving predictive value. Approach. were...
Background: The hemodynamic response to successive vasopressor doses during CPR and its association with survival is poorly defined. Understanding these relationships can facilitate identification of alternative strategies. Hypothesis: Non-survival associated lower responsivity vasopressors. Methods: We performed retrospective analysis data acquired in pediatric swine models (sus scrofa, 9-12kg) asphyxia-associated ventricular fibrillation cardiac arrest use hemodynamic-directed (n=175)....
Introduction: We present a novel demonstration of brain-directed management venoarterial extracorporeal membrane oxygenation (ECMO) using real-time feedback from non-invasive neurometabolic optical monitoring (NOM) the cerebral oxygen extraction fraction (OEF) in pediatric swine. In our prior work, OEF>0.82 was associated with hypoxic-ischemic brain injury during ECMO. Maintaining OEF below this threshold may prevent injury. Hypothesis: Cerebral levels 0.8, 0.7, and 0.6 will be achieved 7...
The effect of cardiac arrest (CA) on cerebral transcriptomics and metabolomics is unknown. We previously demonstrated hemodynamic-directed CPR (HD-CPR) improves survival with favorable neurologic outcomes versus standard (Std-CPR). hypothesized HD-CPR would preserve the transcriptome metabolome compared to Std-CPR.Randomized pre-clinical animal trial.Large resuscitation laboratory at an academic children's hospital.Four-week-old female piglets (8-11 kg).Pigs (1-month-old), three groups: 1)...
Critical Care Medicine: January 2021 - Volume 49 Issue 1 p 387 doi: 10.1097/01.ccm.0000729012.89288.1a
Introduction: Neurologic morbidity is common after pediatric cardiac arrest and inhaled nitric oxide (iNO) may be protective. RNA sequencing have a role in identifying differences gene expression related to neurologic injury following the neuroprotective mechanism of iNO. Hypothesis: We hypothesized that genes energetically intensive functions such as synaptic vesicle trafficking would downregulated this finding less prominent with iNO therapy. Methods: One-month old piglets underwent sham...
Introduction: A critical convergence point for neurologic injury following cardiac arrest is cerebral mitochondrial (Mt) dysfunction, regulated by Mt dynamics (balance of fusion and fission). Both fission are important to homeostasis under normal conditions; however, stress can decrease mass signal apoptosis, while promotes oxidative phosphorylation efficiency. Our group has previously shown hemodynamic directed CPR (HD-CPR) improves bioenergetics compared AHA depth-guided (DG-CPR), which...
Introduction: Cerebral mitochondrial dysfunction is thought to play a role in the post-cardiac arrest syndrome, propagating secondary morbidity and mortality after return of spontaneous circulation (ROSC). Hypothesis: Based on our previous studies showing persistent decrease oxidative phosphorylation (particularly Complex I) increased fission swine model in-hospital cardiac arrest, we hypothesized that nuclear genes related respiratory function would be downregulated promoting upregulated...