Suite 10040 Forbes Tower
Pittsburgh, PA 15260
Phone: 412-647-8287
Fax: 412-864-3400
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Research
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| Department of Emergency Medicine - Research |
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TRANSLATIONAL RESEARCH - The Department of Emergency Medicine has an active investigative program. There are multiple lines of investigation by multiple investigators that are synergistic. A particular strength of the department is the ability to translate basic research to clinical application by virtue of having overlapping interests from faculty with expertise in both basic and clinical investigation. Likewise, the department has prospered by partnering with multiple other specialties in order to address the emergency care of many different diseases. In addition to patient-based clinical research, the Department supports a complete human physiology laboratory, a biochemistry wet-lab, a small animal surgical laboratory, and a large animal surgical laboratory.
HUMAN PERFORMANCE LAB - The Emergency Responder Human Performance Laboratory (HPL) performs research to optimize the health and safety of the individuals who provide emergency care. In addition, the HPL conducts studies of novel treatments or interventions that might be improved by collecting detailed physiological data. Areas of investigation include the acute effects of temperature alterations on cardiovascular performance and stress, the influence of personal protective equipment on cardiovascular stress, and the optimal methods of rehabilitation between bouts of high-intensity rescue work. Several studies have investigated pharmacological adjuncts to facilitate delivery of therapeutic hypothermia as well as the interaction between body temperature and hepatic metabolism of drugs. Other studies investigate the feasibility of performing rescue procedures in varying degrees of protective equipment.
Hostler D, Suyama J. First responder rehab. Good, better, best. JEMS. 2007 Dec; 32(12):98-112; quiz 114.
Moore TM, Callaway CW, Hostler D. Core temperature cooling in healthy volunteers after rapid intravenous infusion of cold and room temperature saline solution. Ann Emerg Med. 2008 Feb;51(2):153-9.
Suyama J, Knutsen CC, Northington WE, Hahn M, Hostler D. IO versus IV access while wearing personal protective equipment in a HazMat scenario. Prehosp Emerg Care. 2007 Oct-Dec;11(4):467-72.
Northington WE, Suyama J, Goss FL, Randall C, Gallagher M, Hostler D. Physiological responses during graded treadmill exercise in chemical-resistant personal protective equipment. Prehosp Emerg Care. 2007 Oct-Dec;11(4):394-8.
Northington WE , Mahoney GM, Hahn ME, Suyama J, Hostler D. Training retention of Level C personal protective equipment use by emergency medical services personnel. Acad Emerg Med. 2007 Oct;14(10):846-9.
Suyama J, Cornett B, Hostler D, Delbridge T. First responder in personal protective equipment with unknown illness during a disaster drill. Prehosp Emerg Care. 2006 Jan-Mar;10(1):103-6.
DISASTER RESPONSE - Members of the department have been involved with development of institutional and organizational policies and protocols for management of disasters. In recent years, particular attention has been devoted to refining the knowledge-base used to approach mass casualties or environmental dangers that might result from terrorism. One goal has been to provide more expedient detecting of biological or radiological contamination of a community through ongoing emergency department-based surveillance.
Kuniak M, Azizova T, Day R, Wald N, Suyama J, Zhang A, Sumina MV, Pesternikova VS, Vasilenko E, Soaita A, Slaughter DM. The Radiation Injury Severity Classification system: an early injury assessment tool for the frontline health-care provider. Br J Radiol. 2008 Mar;81(963):232-43. Epub 2008 Jan 7
Suyama J, Savitz L, Chang H, Allswede M. Financial implications of hospital response to bioterrorism based on diagnosis-related group analysis. Prehosp Disaster Med. 2007 Mar-Apr;22(2):145-8.
Guyette F, Suyama J, Rosen J, Allswede M. Prevalence of radioactive signals from surveillance of an emergency department. Prehosp Disaster Med. 2006 Jul-Aug;21(4):276-81.
Suyama J, Panagos PD, Sztajnkrycer MD, FitzGerald DJ, Barnes D. Injury patterns related to use of less-lethal weapons during a period of civil unrest. J Emerg Med. 2003 Aug;25(2):219-27.
Suyama J, Sztajnkrycer M, Lindsell C, Otten EJ, Daniels JM, Kressel AB. Surveillance of infectious disease occurrences in the community: an analysis of symptom presentation in the emergency department. Acad Emerg Med. 2003 Jul;10(7):753-63.
EMS AIRWAY - A variety of studies investigate the delivery of acute medical care prior to arrival at the hospital. Particular department interests include airway management for acutely decompensating patients: the safest method for controlling the airway may differ in this patient population, in the austere environment outside of the hospital and in the hands of rescuers who are less experienced in airway management. Investigators have examined the training requirements, feasibility of implementation, and effectiveness of alternative approaches to endotracheal intubation in emergency situations.
Wang HE, Katz S. Cognitive control and prehospital endotracheal intubation. Prehosp Emerg Care. 2007 Apr-Jun;11(2):234-9.
Thomas JB, Abo BN, Wang HE. Paramedic perceptions of challenges in out-of-hospital endotracheal intubation. Prehosp Emerg Care. 2007 Apr-Jun;11(2):219-23.
Davis DP, Fakhry SM, Wang HE, Bulger EM, Domeier RM, Trask AL, Bochicchio GV, Hauda WE, Robinson L. Paramedic rapid sequence intubation for severe traumatic brain injury: perspectives from an expert panel. Prehosp Emerg Care. 2007 Jan-Mar;11(1):1-8.
Abo BN, Hostler D, Wang HE. Does the type of out-of-hospital airway interfere with other cardiopulmonary resuscitation tasks? Resuscitation. 2007 Feb;72(2):234-9.
Cole CD, Wang HE, Abo BN, Yealy DM. Drug-assisted effects on protective airway reflexes during out-of-hospital endotracheal intubation (preliminary report). Prehosp Emerg Care. 2006 Oct-Dec;10(4):472-5
Wang HE, Yealy DM. How many attempts are required to accomplish out-of-hospital endotracheal intubation? Acad Emerg Med. 2006 Apr;13(4):372-7
Kim JA, Vogel D, Guimond G, Hostler D, Wang HE, Menegazzi JJ. A randomized, controlled comparison of cardiopulmonary resuscitation performed on the floor and on a moving ambulance stretcher. Prehosp Emerg Care. 2006 Jan-Mar;10(1):68-70.
Wang HE, Kupas DF, Hostler D, Cooney R, Yealy DM, Lave JR. Procedural experience with out-of-hospital endotracheal intubation. Crit Care Med. 2005 Aug;33(8):1718-21.
O'Shea JK, Pinchalk ME, Wang HE. Reliability of paramedic ratings of laryngoscopic views during endotracheal intubation. Prehosp Emerg Care. 2005 Apr-Jun;9(2):167-71.
Wang HE, Seitz SR, Hostler D, Yealy DM. Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care. 2005 Apr-Jun;9(2):156-62.
Guyette FX, Wang H, Cole JS. King airway use by air medical providers. Prehosp Emerg Care. 2007 Oct-Dec;11(4):473-6.
Johnston BD, Seitz SR, Wang HE. Limited opportunities for paramedic student endotracheal intubation training in the operating room. Acad Emerg Med. 2006 Oct;13(10):1051-5.
Guyette FX, Roth KR, LaCovey DC, Rittenberger JC. Feasibility of laryngeal mask airway use by prehospital personnel in simulated pediatric respiratory arrest. Prehosp Emerg Care. 2007 Apr-Jun;11(2):245-9.
Guyette FX, Greenwood MJ, Neubecker D, Roth R, Wang HE. Alternate airways in the prehospital setting (resource document to NAEMSP position statement). Prehosp Emerg Care. 2007 Jan-Mar;11(1):56-61. Review.
Guyette FX, Rittenberger JC, Platt T, Suffoletto B, Hostler D, Wang HE. Feasibility of basic emergency medical technicians to perform selected advanced life support interventions. Prehosp Emerg Care. 2006 Oct-Dec;10(4):518-21.
Wang HE, Seitz SR, Hostler D, Yealy DM. Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care. 2005 Apr-Jun;9(2):156-62.
Epidemiological investigations are determining the influence of provider training, experience and equipment on actual patient outcomes.
Wang HE, Peitzman AB, Cassidy LD, Adelson PD, Yealy DM. Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. Ann Emerg Med. 2004 Nov;44(5):439-50.
Wang HE, Abo BN, Lave JR, Yealy DM. How would minimum experience standards affect the distribution of out-of-hospital endotracheal intubations? Ann Emerg Med. 2007 Sep;50(3):246-52
TRIAGE AND REGIONALIZATION - Regionalization of specialty care also has become important to emergency medicine because of the requirement to triage and transfer patients to different hospitals where specific services are available. These issues receive ongoing attention from emergency medicine within UPMC because of the central role of our department in medical direction of emergency medical services and the large number of emergency departments coordinated by the UPMC health system. From a public health perspective, learning how to make appropriate and rapid matching of resources to patient needs without duplication of services should lead to the most efficient delivery of care.
Lubin JS, Delbridge TR, Cole JS, Nicholas DH, Fore CA, Wadas RJ. EMS and emergency department physician triage: injury severity in trauma patients transported by helicopter. Prehosp Emerg Care. 2005 Apr-Jun;9(2):198-202.
Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Crit Care Med. 2007 Aug;35(8):1928-36.
CLINICAL DECISION SUPPORT - At the same time, the most expensive matching of resources to patient needs occurs when emergency providers decide to admit a patient to the hospital. The department has a long-standing effort to refine and justify this decision. This effort has resulted in systematic development of clinical decision guidelines, calibrated by actual patient data. Major medical situations examined in this research include pneumonia and heart failure.
Hsieh M, Auble TE, Yealy DM. Validation of the Acute Heart Failure Index. Ann Emerg Med. 2008 Jan;51(1):37-44.
Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV Jr, Zucker MI; NEXUS II Investigators. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005 Oct;59(4):954-9.
Auble TE, Hsieh M, McCausland JB, Yealy DM. Comparison of four clinical prediction rules for estimating risk in heart failure. Ann Emerg Med. 2007 Aug;50(2):127-35
Labarere J, Stone RA, Obrosky DS, Yealy DM, Meehan TP, Fine JM, Graff LG, Fine MJ. Comparison of outcomes for low-risk outpatients and inpatients with pneumonia: A propensity-adjusted analysis. Chest. 2007 Feb;131(2):480-8.
Huang DT, Yealy DM. Decision rules and pneumonia: What are we "predicting," and for whom? Am J Respir Crit Care Med. 2006 Dec 1;174(11):1169-70.
Yealy DM, Auble TE, Stone RA, Lave JR, Meehan TP, Graff LG, Fine JM, Obrosky DS, Mor MK, Whittle J, Fine MJ. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):881-94.
Auble TE, Hsieh M, Gardner W, Cooper GF, Stone RA, McCausland JB, Yealy DM. A prediction rule to identify low-risk patients with heart failure. Acad Emerg Med. 2005 Jun;12(6):514-21.
Yealy DM, Auble TE, Stone RA, Lave JR, Meehan TP, Graff LG, Fine JM, Obrosky DS, Edick SM, Hough LJ, Tuozzo K, Fine MJ. The emergency department community-acquired pneumonia trial: Methodology of a quality improvement intervention. Ann Emerg Med. 2004 Jun;43(6):770-82.
TOXICOLOGY - Toxicological emergencies result from intentional and accidental overdoses of many agents. Pittsburgh is the site of the regional poison control center and emergency medicine is the home for the division of toxicology. Investigations by faculty include descriptions and analyses of clinical poisonings. In addition, preclinical studies are conducted to identify novel or optimal treatments for specific poisonings.
Schwartz AR, Pizon AF, Brooks DE. Dextromethorphan-induced serotonin syndrome. Clin Toxicol (Phila). 2008 Mar 27:1-3.
Pizon AF, Schwartz AR, Shum LM, Rittenberger JC, Lower DR, Giannoutsos S, Virji MA, Krasowski MD. Toxicology laboratory analysis and human exposure to p-chloroaniline. Clin Toxicol (Phila). 2008 Jun 14:1-5.
Lo B, Pizon A. Delayed presentation of an aripiprazole overdose. Clin Toxicol (Phila). 2008 Apr;46(4):348-9
Routhier DD, Katz KD, Brooks DE. QTc prolongation and torsades de pointes associated with methadone therapy. J Emerg Med. 2007 Apr;32(3):275-8.
Pizon AF, Brooks DE. Hyperosmolality: another indication for hemodialysis following acute ethylene glycol poisoning. Clin Toxicol (Phila). 2006;44(2):181-3.
SHOCK - There is ongoing research devoted to acute resuscitation of patients with cardiopulmonary collapse or shock. The department of emergency medicine dovetails its efforts with critical care medicine to develop an integrated resuscitation of patients that begins in the ambulance and extends beyond the ICU. Recent work has included projects to better identify occult shock using rapid measurement of lactate, near-infrared spectroscopy or other techniques. A large clinical trial organized is being conducted in emergency departments to compare outcomes after resuscitation of sepsis using different protocols (including “early goal-directed therapy”). Another multicenter trial is comparing outcomes when different resuscitation fluids are used in the ambulance to begin resuscitation of injured patients with hemorrhagic shock.
Wang HE, Callaway CW, Peitzman AB, Tisherman SA. Admission hypothermia and outcome after major trauma. Crit Care Med. 2005 Jun;33(6):1296-301.
Yende S, D'Angelo G, Kellum JA, Weissfeld L, Fine J, Welch RD, Kong L, Carter M, Angus DC; GenIMS Investigators. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med. 2008 Jun 1;177(11):1242-7.
Kellum JA, Kong L, Fink MP, Weissfeld LA, Yealy DM, Pinsky MR, Fine J, Krichevsky A, Delude RL, Angus DC; GenIMS Investigators. Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. Arch Intern Med. 2007 Aug 13-27;167(15):1655-63.
CARDIAC ARREST RESUSCITATION - When patients progress to cardiac arrest, other investigations have set out to identify optimal steps to achieve restoration of circulation, as well as optimal steps to restore neurological function. Preclinical studies have examined the effects of drugs and chest compression strategies on the likelihood of restoring a pulse after cardiac arrest. Titration of resuscitative therapy based on real-time analysis of waveform characteristics has been explored in great detail. Other investigations have examined the biochemical mechanisms and details of induced hypothermia as a strategy to improve brain recovery during the first day after cardiac arrest.
Rittenberger JC, Suffoletto B, Salcido D, Logue E, Menegazzi JJ. Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation. Resuscitation. 2008 Jul 10. [Epub ahead of print]
Mader TJ, Menegazzi JJ, Rittenberger JC, Suffoletto BS, Callaway CW, Salcido DD, Logue ES, Sherman LD. The effect of adenosine a(1) receptor antagonism on return of spontaneous circulation and short-term survival in prolonged ventricular fibrillation. Prehosp Emerg Care. 2008 Jul-Sep;12(3):352-8.
Menegazzi JJ, Salcido DD, Menegazzi MT, Rittenberger JC, Suffoletto BP, Logue ES, Mader TJ. Effects of an impedance threshold device on hemodynamics and restoration of spontaneous circulation in prolonged porcine ventricular fibrillation. Prehosp Emerg Care. 2007 Apr-Jun;11(2):179-85.
D'Cruz BJ, Logue ES, Falke E, DeFranco DB, Callaway CW. Hypothermia and ERK activation after cardiac arrest. Brain Res. 2005 Dec 7;1064(1-2):108-18. Epub 2005 Nov 14.
Logue ES, McMichael MJ, Callaway CW. Comparison of the effects of hypothermia at 33 degrees C or 35 degrees C after cardiac arrest in rats. Acad Emerg Med. 2007 Apr;14(4):293-300
Betz AE, Menegazzi JJ, Logue ES, Callaway CW, Wang HE. A randomized comparison of manual, mechanical and high-impulse chest compression in a porcine model of prolonged ventricular fibrillation. Resuscitation. 2006 Jun;69(3):495-501. Epub 2006 Mar 24.
Reynolds JC, Rittenberger JC, Menegazzi JJ. Drug administration in animal studies of cardiac arrest does not reflect human clinical experience. Resuscitation. 2007 Jul;74(1):13-26. Epub 2007 Mar 13. Review.
Rittenberger JC, Menegazzi JJ, Callaway CW. Association of delay to first intervention with return of spontaneous circulation in a swine model of cardiac arrest. Resuscitation. 2007 Apr;73(1):154-60. Epub 2007 Jan 16.
Callaway CW, Ramos R, Logue ES, Betz AE, Wheeler M, Repine MJ. Brain-derived neurotrophic factor does not improve recovery after cardiac arrest in rats. Neurosci Lett. 2008 Aug 13. [Epub ahead of print]
Callaway CW, Rittenberger JC, Logue ES, McMichael MJ. Hypothermia after cardiac arrest does not alter serum inflammatory markers. Crit Care Med. 2008 Aug 1. [Epub ahead of print]
Vosler PS, Logue ES, Repine MJ, Callaway CW. Delayed hypothermia preferentially increases expression of brain-derived neurotrophic factor exon III in rat hippocampus after asphyxial cardiac arrest. Brain Res Mol Brain Res. 2005 Apr 27;135(1-2):21-9. Epub 2005 Jan 7.
Sherman LD, Rea TD, Waters JD, Menegazzi JJ, Callaway CW. Logarithm of the absolute correlations of the ECG waveform estimates duration of ventricular fibrillation and predicts successful defibrillation. Resuscitation. 2008 Sep;78(3):346-54. Epub 2008 Jul 1.
Mader TJ, Menegazzi JJ, Rittenberger JC, Suffoletto BS, Callaway CW, Salcido DD, Logue ES, Sherman LD. The effect of adenosine A1 receptor antagonism on return of spontaneous circulation and short-term survival in prolonged ventricular fibrillation. Prehosp Emerg Care. 2008 Jul-Sep;12(3):352-8.
Menegazzi JJ, Ramos R, Wang HE, Callaway CW. Post-resuscitation hemodynamics and relationship to the duration of ventricular fibrillation. Resuscitation. 2008 Sep;78(3):355-8. Epub 2008 Jun 24.
Ho Y, Logue E, Callaway CW, DeFranco DB. Different mechanisms account for extracellular-signal regulated kinase activation in distinct brain regions following global ischemia and reperfusion. Neuroscience. 2007 Mar 2;145(1):248-55
Changes in thrombosis and inflammation are examined in both animals and patients. Feasible and economical implementation of proven critical care interventions has been demonstrated in the regional tertiary care center. Finally, the department participates in multicenter trials to test different strategies for cardiopulmonary resuscitation after out-of-hospital cardiac arrest. Recent trials tested the effects of vasopressin as a resuscitation medication, the effectiveness of mechanical CPR devices, and the utility of public access defibrillation. Ongoing trials will examine timing of defibrillation and use of circulatory adjuncts during CPR. These trials have afforded us with significant institutional experience on performing research in emergency situations while abiding by or accounting for ethical standards for informed consent.
Mosesso VN Jr, Brown LH, Greene HL, Schmidt TA, Aufderheide TP, Sayre MR, Stephens SW, Travers A, Craven RA, Weisfeldt ML; PAD Trial Investigators. Conducting research using the emergency exception from informed consent: the Public Access Defibrillation (PAD) Trial experience. Resuscitation. 2004 Apr;61(1):29-36.
Mosesso VN Jr, Cone DC. Using the exception from informed consent regulations in research. Acad Emerg Med. 2005 Nov;12(11):1031-9.
Guyette FX, Guimond GE, Hostler D, Callaway CW. Vasopressin administered with epinephrine is associated with a return of a pulse in out-of-hospital cardiac arrest. Resuscitation. 2004 Dec;63(3):277-82.
Wang HE, Min A, Hostler D, Chang CC, Callaway CW. Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest. Resuscitation. 2005 Oct;67(1):69-74.
Rittenberger JC, Kelly E, Jang D, Greer K, Heffner A. Successful outcome utilizing hypothermia after cardiac arrest in pregnancy: a case report. Crit Care Med. 2008 Apr;36(4):1354-6.
Rittenberger JC, Hostler DP, Tobin T, Gaines J, Callaway CW. Predictors of ROSC in witnessed aeromedical cardiac arrests. Resuscitation. 2008 Jan;76(1):43-6. Epub 2007 Aug 3.
Hostler D, Rittenberger JC, Roth R, Callaway CW. Increased chest compression to ventilation ratio improves delivery of CPR. Resuscitation. 2007 Sep;74(3):446-52. Epub 2007 Mar 23.
Hostler D, Callaway CW, Newman DH, D'Cruz B. Thrombin-antithrombin appearance in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2007 Jan-Mar;11(1):9-13.
Callaway CW, Hostler D, Doshi AA, Pinchalk M, Roth RN, Lubin J, Newman DH, Kelly LJ. Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest. Am J Cardiol. 2006 Nov 15;98(10):1316-21. Epub 2006 Sep 26.
Rittenberger JC, Martin JR, Kelly LJ, Roth RN, Hostler D, Callaway CW. Inter-rater reliability for witnessed collapse and presence of bystander CPR. Resuscitation. 2006 Sep;70(3):410-5. Epub 2006 Jun 27.
Rittenberger JC, Bost JE, Menegazzi JJ. Time to give the first medication during resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2006 Aug;70(2):201-6. Epub 2006 Jun 27. Review.
Rittenberger JC, Guimond G, Platt TE, Hostler D. Quality of BLS decreases with increasing resuscitation complexity. Resuscitation. 2006 Mar;68(3):365-9. Epub 2005 Dec 27.
Lo BM, Quinn SM, Hostler D, Callaway CW. Rescue shock outcomes during out-of-hospital cardiac arrest. Resuscitation. 2007 Dec;75(3):469-75. Epub 2007 Jul 17.
Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN Jr, Van Ottingham L, Olsufka M, Pennington S, White LJ, Yahn S, Husar J, Morris MF, Cobb LA. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA. 2006 Jun 14;295(22):2620-8.
Aufderheide TP, Kudenchuk PJ, Hedges JR, Nichol G, Kerber RE, Dorian P, Davis DP, Idris AH, Callaway CW, Emerson S, Stiell IG, Terndrup TE; The ROC Investigators. Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods Part 1: Rationale and methodology for the impedance threshold device (ITD) protocol. Resuscitation. 2008 Aug;78(2):179-185. Epub 2008 May 19.
Morrison LJ, Nichol G, Rea TD, Christenson J, Callaway CW, Stephens S, Pirrallo RG, Atkins DL, Davis DP, Idris AH, Newgard C; ROC Investigators. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Resuscitation. 2008 Aug;78(2):161-9. Epub 2008 May 13. |
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| Contact Information | Clifton W. Callaway, MD, PhD
(412) 647-3078
callawaycw@upmc.edu
Iroquois 400A,
Pittsburgh, PA 15261 | | |
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