# The Hemodynamic and Metabolic Effects of Advanced Circulatory Support for Resuscitation

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $779,108

## Abstract

There are over 350,000 victims of out-of-hospital cardiac arrest each year in the United States, and the
success rates from cardiopulmonary resuscitation (CPR) average only about 10%. In addition, organ shortage
is the greatest challenge facing organ transplantation, with far fewer donors than needed, and many patients
dying awaiting transplant. Approaches that could enhance survival from cardiac arrest, and also increase the
number of organ donors, are, therefore, critically needed. One approach is implementing systems to enhance
blood flow during cardiac arrest, since enhanced flow increases survival. Even after 50 minutes of cardiac
arrest, Extracorporeal Membrane Oxygenation (ECMO) can double survival rates over those from conventional
CPR. More than half of cardiac arrest victims treated with ECMO do not, however, have return of spontaneous
circulation (ROSC), and some patients with ROSC are brain dead. Patients with ongoing ECMO, but without
ROSC, or with brain death, represent a large pool of viable donors. Current ECMO systems, however, require
substantial special training for vascular access, and a perfusionist, limiting their widespread use. Newer ECMO
systems are being developed that allow more flow through shorter cannulas than with current systems. It is not
known, however, how much flow is needed for survival. If the critical amount of flow needed can be achieved
with the shorter cannulas used with the newer systems, then shorter, easier to place, and less morbid cannulas
can be used routinely, extending the use of ECMO to wider patient populations, including underserved areas.
We have developed an MRI compatible ECMO system and are using it while acquiring real-time magnetic
resonance derived cerebral flow, oxygen metabolism, and metabolite levels. Study of these brain parameters is
critical since brain function is the most important determinant of survival from cardiac arrest. The hypotheses
we are testing are that: 1) Metabolic parameters and cerebral blood flow will be preserved by critical amounts
of blood flow generated during resuscitation; 2) There are critical levels of blood flow that are needed during
resuscitation for neurologically intact survival; 3) There are critical levels of metabolic parameters, brain injury
biomarkers, inflammatory markers, and reactive oxygen species, measured during resuscitation, that predict
neurologically intact survival; 4) Adding CPR will reduce the amount of ECMO flow needed for survival; 5)
Intra-arrest hypothermia will reduce the amount of flow needed for survival; and 6) Reactive oxygen species
generated during resuscitation can be suppressed by critical levels of flow and hypothermia. One goal of this
program is to study the hemodynamic and metabolic effects of using an ECMO system that can be used without
a perfusionist, and that uses cannulas that can be inserted percutaneously by a markedly increased pool of
physicians. Another goal is to understand the determinants of survival and...

## Key facts

- **NIH application ID:** 10767289
- **Project number:** 5R01HL155760-04
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** HENRY R HALPERIN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $779,108
- **Award type:** 5
- **Project period:** 2021-03-15 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10767289

## Citation

> US National Institutes of Health, RePORTER application 10767289, The Hemodynamic and Metabolic Effects of Advanced Circulatory Support for Resuscitation (5R01HL155760-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10767289. Licensed CC0.

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