Karl B Kern

Interests

Research

Dr. Kern's research interests are in cardiopulmonary resuscitation and coronary blood flow. He is the coordinator of the University of Arizona Sarver Heart Center Cardiopulmonary Resuscitation Research Group. He was inducted as an honorary member of the European Resuscitation Council in 2014 and named a CPR Giant by the International Liaison Committee on Resuscitation in 2015. He has been awarded numerous American Heart Association grants, an AHA-Flinn Young Investigator award, and two three-year awards from the Arizona Disease Control Research Commission grant in the area of basic CPR research, and one three year award to perform an investigator-initiated pilot RCT of early cath versus no early cath for those post cardiac arrest without ST elevation. He has published over 250 scholarly reports, including 180 peer-reviewed original scientific articles.

Teaching

Dr. Kern has received numerous honors for excellence in teaching. He was voted House Officer Educator of the Year and is on the Dean's List for Excellence in Teaching. In 1995-96, he was a Dean’s Teaching Scholar at The University of Arizona College of Medicine. He received the Cardiology Fellowship Teaching or Mentoring Awards in 1996, 1999, 2001, 2008, 2009 and the Cardiology Interventional Lifetime EducationalExcellence award in 2015. Dr. Kern has been a Visiting Professor at the Sao Paulo School of Medicine, Sao Paulo, Brazil, and at The Leopold-Franzeus University of Innsbruck in Innsbruck, Austria.

Courses

Scholarly Contributions

Books

• Kern, K. B. (2007). Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd Edition. Cambridge University Press.

Chapters

• Kern, K. B. (2016). Post Resuscitation Care. In American College of Cardiology ACCSAP 9(pp 147-158).
• Kern, K. B. (2014). Improving Survival from Out-of-Hospital Cardiac Arrest with Bystander Chest Compression-Only CPR: The First Component of Cardiocerebral Resuscitation. In Resuscitation. Springer, Milano. doi:10.1007/978-88-470-5507-0_9
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  Out-of-hospital sudden cardiac arrest remains a major public health problem throughout the world. Survival is most likely when cardiopulmonary resuscitation (CPR) is begun within 1 or 2 min of collapse. Bystander willingness to provide immediate resuscitation efforts are the real key to surviving such an event. Chest compression-only CPR is a simplified, basic-life support alternative to standard CPR for lay rescuers. The elimination of mouth-to-mouth breathing makes this alternative easier to learn and more palatable to actually perform. Public education campaigns concentrating on chest compression-only CPR can produce significant increases in the local incidence of bystander CPR. Increased bystander resuscitation efforts result in increased community survival rates from out-of-hospital cardiac arrest and, most importantly, increased preservation of central nervous system function among individual survivors.
• Gazmuri, R. J., Weil, M. H., Kern, K. B., Tang, W., Ayoub, I. M., Kolarova, J., & Radhakrishan, J. (2007). Prevention and Therapy of Postresuscitation Myocardial Dysfunction. In Cardiac Arrest: The Science and Practice of Resuscitation Medicine.(pp 829-847). Cambridge University Press.
• Kern, K. B., Niemann, J. T., & Steen, S. (2007). Coronary Perfusion Pressure during Cardiopulmonary Resuscitation. In Cardiac Arrest: The Science and Practice of Resuscitation Medicine(pp 369-388). Cambridge University Press.
• Marko, N., Bjorn, B., & Kern, K. B. (2007). Percutaneous Coronary Intervention (PCI) After Successful Reestablishment of Spontaneous Circulation and During Cardiopulmonary Resuscitation. In Cardiac Arrest: The Science and Practice of Resuscitation Medicine(pp 764-771).
• Bellah, K., & Kern, K. B. (1998). Congestive Heart Failure. In Decision Making in Medicine - An Algorithmic Approach (2nd Edition)(pp 86-87). Mosby Inc.
• McKenzie, S., & Kern, K. B. (1992). Counseling After Myocardial Infarction. In Decision Making in Medicine(pp 82-83). Decker, Mosby Year Book Inc.

Journals/Publications

• Harhash, A. A., May, T., Hsu, C. H., Seder, D. B., Dankiewicz, J., Agarwal, S., Patel, N., McPherson, J., Riker, R., Soreide, E., Hirsch, K. G., Stammet, P., Dupont, A., Forsberg, S., Rubertsson, S., Friberg, H., Nielsen, N., Mooney, M. R., & Kern, K. B. (2021). Incidence of cardiac interventions and associated cardiac arrest outcomes in patients with nonshockable initial rhythms and no ST elevation post resuscitation. Resuscitation, 167, 188-197.
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  Out of Hospital Cardiac arrest (OHCA) survivors with ST elevation (STE) with or without shockable rhythms often benefit from coronary angiography (CAG) and, if indicated, percutaneous coronary intervention (PCI). However, the benefits of CAG and PCI in OHCA survivors with nonshockable rhythms (PEA/asystole) and no STE are debated.
• Patel, N., Søreide, E., Stammet, P., Soreide, E., Seder, D. B., Rubertsson, S., Riker, R. R., Rab, T., Patel, N. C., Nielsen, N., Mooney, M. R., Mcpherson, J. A., Mcmullan, P. W., May, T. L., Kern, K. B., Hsu, C. H., Hirsch, K. G., Harhash, A. A., Friberg, H., , Dupont, A., et al. (2021). Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography.. Journal of the American College of Cardiology, 77(4), 360-371. doi:10.1016/j.jacc.2020.11.043
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  The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival..This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis..Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed "unfavorable feature" on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes..Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age >85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC >30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate >7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH 30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge..Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable.
• Roka-Moiia, Y., Li, M., Ivich, A., Muslmani, S., Kern, K. B., & Slepian, M. J. (2021). Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility. ASAIO journal (American Society for Artificial Internal Organs : 1992), 66(10), 1142-1151.
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  Despite growing use of mechanical circulatory support, limitations remain related to hemocompatibility. Here, we performed a head-to-head comparison of the hemocompatibility of a centrifugal cardiac assist system-the Centrimag, with that of the latest generation of an intravascular microaxial system-the Impella 5.5. Specifically, hemolysis, platelet activation, microparticle (MP) generation, and von Willebrand factor (vWF) degradation were evaluated for both devices. Freshly obtained porcine blood was recirculated within device propelled mock loops for 4 hours, and alteration of the hemocompatibility parameters was monitored over time. We found that the Impella 5.5 and Centrimag exhibited low levels of hemolysis, as indicated by minor increase in plasma free hemoglobin. Both devices did not induce platelet degranulation, as no alteration of β-thromboglobulin and P-selectin in plasma occurred, rather minor downregulation of platelet surface P-selectin was detected. Furthermore, blood exposure to shear stress via both Centrimag and Impella 5.5 resulted in a minor decrease of platelet count with associated ejection of procoagulant MPs, and a decrease of vWF functional activity (but not plasma level of vWF-antigen). Greater MP generation was observed with the Centrimag relative to the Impella 5.5. Thus, the Impella 5.5 despite having a lower profile and higher impeller rotational speed demonstrated good and equivalent hemocompatibility, in comparison with the predicate Centrimag, with the advantage of lower generation of MPs.
• Truong, H. T., Tran, A., Smith, N., Shanmugasundaram, M., Noc, M., Kern, K. B., Hsu, P., Ho, D., Harhash, A., & Ciurlino, B. (2021). Extending Time to Reperfusion with Mild Therapeutic Hypothermia: A New Paradigm for Providing Primary Percutaneous Coronary Intervention to Remote ST Segment Elevation Myocardial Infarction Patients.. Therapeutic hypothermia and temperature management, 11(1), 45-52. doi:10.1089/ther.2019.0039
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  Primary percutaneous coronary intervention (PPCI) is the preferred treatment for acute ST segment elevation myocardial infarction (STEMI). The goal is reperfusion within 90 minutes of first medical contact (FMC) or 120 minutes if transfer is needed. Otherwise, fibrinolytic therapy is recommended. Mild therapeutic hypothermia (MTH) (≤35°C) before coronary reperfusion decreases myocardial infarct size. If applied before reperfusion, hypothermia could potentially lengthen the FMC-reperfusion time without increasing infarct size. Thirty-six swine had their mid left anterior descending coronary artery acutely occluded. All animals had an initial 30 minutes of occlusion to simulate typical delay before seeking medical attention. Eighteen animals were studied under normothermic conditions with reperfusion after an additional 40 minutes (the porcine equivalent of a 120-minute clinical FMC to reperfusion time) and 18 were treated with hypothermia but not reperfused until another 80 minutes (clinical equivalent of 240 minutes). Primary outcome was myocardial infarct size (infarct/area at risk [AAR]) at 24 hours. The two groups differed in systemic temperature at the time of reperfusion (39.1°C ± 1.0°C vs. 35.5°C ± 0.7°C; p < 0.0001). Myocardial infarct size was not significantly different despite the longer time to reperfusion in those treated with hypothermia (60.6% ± 12% of the AAR [normothermic] vs. 65.8% ± 11.8% of the AAR [hypothermic]; p = 0.39). Rapid induction of MTH during an anterior STEMI made it possible to extend the FMC to reperfusion time by the equivalent of an extra two clinical hours (120-240 minutes) without increasing the myocardial infarct size. This strategy could allow more STEMI patients to receive PPCI rather than the less effective intravenous fibrinolysis.
• Acharya, D., Torabi, M., Borgstrom, M., Rajapreyar, I., Lee, K., Kern, K., Rycus, P., Tonna, J. E., Alexander, P., & Lotun, K. (2020). Extracorporeal Membrane Oxygenation in Myocardial Infarction Complicated by Cardiogenic Shock: Analysis of the ELSO Registry. Journal of the American College of Cardiology, 76(8), 1001-1002.
• Böttiger, B. W., Becker, L. B., Kern, K. B., Lippert, F., Lockey, A., Ristagno, G., Semeraro, F., & Wingen, S. (2020). BIG FIVE strategies for survival following out-of-hospital cardiac arrest. European journal of anaesthesiology, 37(11), 955-958.
• Böttiger, B. W., Lockey, A., Aickin, R., Carmona, M., Cassan, P., Castrén, M., Chakra Rao, S., De Caen, A., Escalante, R., Georgiou, M., Hoover, A., Kern, K. B., Khan, A. M., Levi, C., Lim, S. H., Nadkarni, V., Nakagawa, N. V., Nation, K., Neumar, R. W., , Nolan, J. P., et al. (2020). Up to 206 Million People Reached and Over 5.4 Million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative. Journal of the American Heart Association, 9(15), e017230.
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  Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. "All citizens of the world can save a life-CHECK-CALL-COMPRESS." With these words, the International Liaison Committee on Resuscitation launched the 2019 global "World Restart a Heart" initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, "CHECK-CALL-COMPRESS," will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.
• Kern, K. B. (2020). Impella 5.5 versus Centrimag: A head to head comparison of device hemocompatibility. ASAIO. doi:DOI: 10.1097?MAT.0000000000001283.
• Kern, K. B., Radsel, P., Jentzer, J. C., Seder, D. B., Lee, K. S., Lotun, K., Janardhanan, R., Stub, D., Hsu, C. H., & Noc, M. (2020). Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study. Circulation, 142(21), 2002-2012.
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  The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation.
• Kiguchi, T., Okubo, M., Nishiyama, C., Maconochie, I., Ong, M. E., Kern, K. B., Wyckoff, M. H., McNally, B., Christensen, E. F., Tjelmeland, I., Herlitz, J., Perkins, G. D., Booth, S., Finn, J., Shahidah, N., Shin, S. D., Bobrow, B. J., Morrison, L. J., Salo, A., , Baldi, E., et al. (2020). Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation, 152, 39-49.
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  Since development of the Utstein style recommendations for the uniform reporting of cardiac arrest, increasing numbers of national and regional out-of-hospital cardiac arrest (OHCA) registries have been established worldwide. The International Liaison Committee on Resuscitation (ILCOR) created the Research and Registries Working Group and aimed to systematically report data collected from these registries.
• Levy, M., Kern, K. B., Yost, D., Chapman, F. W., & Hardig, B. M. (2020). Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest. Journal of the American College of Emergency Physicians open, 1(6), 1214-1221.
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  The quality of cardiopulmonary resuscitation (CPR) affects outcomes from cardiac arrest, yet manual CPR is difficult to administer. Although mechanical CPR (mCPR) devices offer high quality CPR, only limited data describe their deployment, their interaction with standard manual CPR (sCPR), and the consequent effects on chest compression continuity and patient outcomes. We sought to describe the interaction between sCPR and mCPR and the impact of the sCPR-mCPR transition upon outcomes in adult out-of-hospital cardiac arrest (OHCA).
• May, T., Skinner, K., Unger, B., Mooney, M., Patel, N., Dupont, A., McPherson, J., McMullan, P., Nielsen, N., Seder, D. B., & Kern, K. B. (2020). Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death. Journal of the American Heart Association, 9(7), e015629.
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  Background Coronary artery disease is the primary etiology for sudden cardiac arrest in adults, but potential differences in the incidence and utility of invasive coronary testing between resuscitated men and women have not been extensively evaluated. Our aim was to characterize angiographic similarities and differences between men and women after cardiac arrest. Methods and Results Data from the International Cardiac Arrest Registry-Cardiology database included patients resuscitated from out-of-hospital cardiac arrest of presumed cardiac origin, admitted to 7 academic cardiology/resuscitation centers during 2006 to 2017. Demographics, clinical factors, and angiographic findings of subjects were evaluated in relationship to sex and multivariable logistic regression models created to predict both angiography and outcome. Among 966 subjects, including 277 (29%) women and 689 (71%) men, fewer women had prior coronary artery disease and more had prior congestive heart failure (=0.05). Women were less likely to have ST-segment-elevation myocardial infarction (32% versus 39%, =0.04). Among those with ST-segment-elevation myocardial infarctions, identification and distribution of culprit arteries was similar between women and men, and there were no differences in treatment or outcome. In patients without ST-segment elevation post-arrest, women were overall less likely to undergo coronary angiography (51% versus 61%,
• Seder, D. B., May, T., Kern, K. B., Hsu, C. H., & Harhash, A. (2020). RISK STRATIFYING CARDIAC ARREST SURVIVORS FOR CORONARY ANGIOGRAPHY: WHERE DO WE DRAW THE LINE. Journal of the American College of Cardiology, 75(11), 1336. doi:10.1016/s0735-1097(20)31963-x
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  Coronary angiography (CAG) and percutaneous coronary intervention (PCI) have been shown to improve outcomes among cardiac arrest (CA) survivors. American College of Cardiology Interventional Council published recommendations to risk stratify survivors for CAG +/- PCI, particularly to identify those
• Shanmugasundaram, M., Truong, H. T., Harhash, A., Ho, D., Tran, A., Smith, N., Ciurlino, B., Noc, M., Hsu, P., & Kern, K. B. (2020). Extending Time to Reperfusion with Mild Therapeutic Hypothermia: A New Paradigm for Providing Primary Percutaneous Coronary Intervention to Remote ST Segment Elevation Myocardial Infarction Patients. Therapeutic hypothermia and temperature management.
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  Primary percutaneous coronary intervention (PPCI) is the preferred treatment for acute ST segment elevation myocardial infarction (STEMI). The goal is reperfusion within 90 minutes of first medical contact (FMC) or 120 minutes if transfer is needed. Otherwise, fibrinolytic therapy is recommended. Mild therapeutic hypothermia (MTH) (≤35°C) before coronary reperfusion decreases myocardial infarct size. If applied before reperfusion, hypothermia could potentially lengthen the FMC-reperfusion time without increasing infarct size. Thirty-six swine had their mid left anterior descending coronary artery acutely occluded. All animals had an initial 30 minutes of occlusion to simulate typical delay before seeking medical attention. Eighteen animals were studied under normothermic conditions with reperfusion after an additional 40 minutes (the porcine equivalent of a 120-minute clinical FMC to reperfusion time) and 18 were treated with hypothermia but not reperfused until another 80 minutes (clinical equivalent of 240 minutes). Primary outcome was myocardial infarct size (infarct/area at risk [AAR]) at 24 hours. The two groups differed in systemic temperature at the time of reperfusion (39.1°C ± 1.0°C vs. 35.5°C ± 0.7°C;  
• Shetty, R., Lee, K. S., Torabi, M., Tonna, J. E., Shetty, R., Rycus, P., Rajapreyar, I., Lotun, K., Lee, K. S., Kern, K. B., Borgstrom, M., Alexander, P., & Acharya, D. (2020). CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK RECEIVING EXTRACORPOREAL LIFE SUPPORT. Journal of the American College of Cardiology, 75(11), 1231. doi:10.1016/s0735-1097(20)31858-1
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  Refractory cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) has high mortality. The underlying cardiovascular diagnosis may influence outcomes and have implications for patient selection and management on ECMO. This study evaluated outcomes of patients with
• Timerman, S., Rochitte, C. E., Ribeiro, E. E., Polastri, T. F., Oliveira, M. T., Nomura, C., Nicolau, J. C., Neto, P. A., Lima, F. G., Lage, S. G., Kern, K. B., Kalil, R., Hajjar, L. A., Giannetti, N., Dallan, L. A., Dae, M., & Bernoche, C. (2020). CRT-500.15 Cold Saline Versus Regular Saline in Endovascular Therapeutic Hypothermia in Acute ST Segment Elevation Myocardial infarction. Jacc-cardiovascular Interventions, 13(4), S45. doi:10.1016/j.jcin.2020.01.146
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  Therapeutic hypothermia (TH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrests; however, the role of cold saline as an adjuvant therapy to endovascular cooling in STEMI remains controversial. The aim was the evaluation of infusion of cold saline versus no cold saline
• Harhash, A. A., Huang, J. J., Howe, C. L., Hsu, C. H., & Kern, K. B. (2019). Coronary angiography and percutaneous coronary intervention in cardiac arrest survivors with non-shockable rhythms and no STEMI: A systematic review. Resuscitation, 143, 106-113.
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  Emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) are thought to improve outcomes in cardiac arrest (CA) survivors with ST segment elevation myocardial infarction (STEMI) and those without STEMI but likely cardiac etiology (shockable rhythms). However, the role of CAG ± PCI in OHCA survivors with non-shockable rhythms and no STEMI post-resuscitation remains unclear.
• Harhash, A. A., Huang, J. J., Reddy, S., Natarajan, B., Balakrishnan, M., Shetty, R., Hutchinson, M. D., & Kern, K. B. (2019). aVR ST Segment Elevation: Acute STEMI or Not? Incidence of an Acute Coronary Occlusion. The American journal of medicine, 132(5), 622-630.
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  Identification of ST elevation myocardial infarction (STEMI) is critical because early reperfusion can save myocardium and increase survival. ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines. We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multilead ST depression.
• Kern, K. B., Colberg, T. P., Wunder, C., Newton, C., & Slepian, M. J. (2019). A local neighborhood volunteer network improves response times for simulated cardiac arrest. Resuscitation, 144, 131-136.
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  Each minute is crucial in the treatment of out-of-hospital cardiac arrest (CA). Immediate chest compressions and early defibrillation are keys to good outcomes. We hypothesized that a coordinated effort of alerting trained local neighborhood volunteers (vols) simultaneously with 911 activation of professional EMS providers would result in substantial decreases in call-to-arrival times, leading to earlier CPR and defibrillation.
• Lotun, K., Truong, H. T., Cha, K. C., Alsakka, H., Gianotto-Oliveira, R., Smith, N., Rao, P., Bien, T., Chatelain, S., Kern, M. C., Hsu, C. H., Zuercher, M., & Kern, K. B. (2019). Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance. JACC. Cardiovascular interventions, 12(18), 1840-1849.
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  The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.
• Madsen Hardig, B., Kern, K. B., & Wagner, H. (2019). Mechanical chest compressions for cardiac arrest in the cath-lab: when is it enough and who should go to extracorporeal cardio pulmonary resuscitation?. BMC cardiovascular disorders, 19(1), 134.
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  Treating patients in cardiac arrest (CA) with mechanical chest compressions (MCC) during percutaneous coronary intervention (PCI) is now routine in many coronary catheterization laboratories (cath-lab) and more aggressive treatment modalities, including extracorporeal CPR are becoming more common. The cath-lab setting enables monitoring of vital physiological parameters and other clinical factors that can potentially guide the resuscitation effort. This retrospective analysis attempts to identify such factors associated with ROSC and survival.
• May, T. L., Lary, C. W., Riker, R. R., Friberg, H., Patel, N., Søreide, E., McPherson, J. A., Undén, J., Hand, R., Sunde, K., Stammet, P., Rubertsson, S., Belohlvaek, J., Dupont, A., Hirsch, K. G., Valsson, F., Kern, K., Sadaka, F., Israelsson, J., , Dankiewicz, J., et al. (2019). Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive care medicine, 45(5), 637-646.
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  Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.
• Panchal, A., Keim, S., Ewy, G., Kern, K., Hughes, K. E., & Beskind, D. (2019). Development of a Medical Student Cardiopulmonary Resuscitation Elective to Promote Education and Community Outreach. Cureus, 11(4), e4507.
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   One of the barriers to improving cardiac arrest survival is the low rate of cardiopulmonary resuscitation (CPR) provision. Identifying this as a public health issue, many medical students often assist in training the community in CPR. However, these experiences are often short and are not associated with structured resuscitation education, limiting the student's and the community's learning. In this assessment, we identified a need and developed a curriculum, including defined goals and objectives, for an undergraduate medical education (UME) elective in CPR.
• Vane, M. F., Carmona, M. J., Pereira, S. M., Kern, K. B., Timerman, S., Perez, G., Vane, L. A., Otsuki, D. A., & Auler, J. O. (2019). Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study. Scientific reports, 9(1), 14975.
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  Data on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80-0.93]), with a sensitivity and specificity of 78.4% [69.6-86.3%] and 89.3% [80.4-96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792-0.956]), with a sensitivity of 79.3% [65.5-93.1%] and specificity of 86.1 [74.4-95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.
• Wong, G., Wang, T. L., Toporas, C., Stanton, D., Rao, S. S., Perkins, G. D., Nolan, J. P., Neumar, R. W., Nation, K., Nadkarni, V., Lockey, A., Lim, S. H., Khan, A. M., Kern, K. B., Georgiou, M., Gent, L. M., Escalante, R., Censullo, E., Castren, M., , Caen, A. D., et al. (2019). Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide - The "World Restart a Heart (WRAH)" initiative 2018.. Resuscitation, 138, 15-17. doi:10.1016/j.resuscitation.2019.02.033
• Yannopoulos, D., Bartos, J. A., Aufderheide, T. P., Callaway, C. W., Deo, R., Garcia, S., Halperin, H. R., Kern, K. B., Kudenchuk, P. J., Neumar, R. W., Raveendran, G., & , A. H. (2019). The Evolving Role of the Cardiac Catheterization Laboratory in the Management of Patients With Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation, 139(12), e530-e552.
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  Coronary artery disease is prevalent in different causes of out-of-hospital cardiac arrest (OHCA), especially in individuals presenting with shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). The purpose of this report is to review the known prevalence and potential importance of coronary artery disease in patients with OHCA and to describe the emerging paradigm of treatment with advanced perfusion/reperfusion techniques and their potential benefits on the basis of available evidence. Although randomized clinical trials are planned or ongoing, current scientific evidence rests principally on observational case series with their potential confounding selection bias. Among patients resuscitated from VF/pVT OHCA with ST-segment elevation on their postresuscitation ECG, the prevalence of coronary artery disease has been shown to be 70% to 85%. More than 90% of these patients have had successful percutaneous coronary intervention. Conversely, among patients resuscitated from VF/pVT OHCA without ST-segment elevation on their postresuscitation ECG, the prevalence of coronary artery disease has been shown to be 25% to 50%. For these patients, early access to the cardiac catheterization laboratory is associated with a 10% to 15% absolute higher functionally favorable survival rate compared with more conservative approaches of late or no access to the cardiac catheterization laboratory. In patients with VF/pVT OHCA refractory to standard treatment, a new treatment paradigm is also emerging that uses venoarterial extracorporeal membrane oxygenation to facilitate return of normal perfusion and to support further resuscitation efforts, including coronary angiography and percutaneous coronary intervention. The burden of coronary artery disease is high in this patient population, presumably causative in most patients. The strategy of venoarterial extracorporeal membrane oxygenation, coronary angiography, and percutaneous coronary intervention has resulted in functionally favorable survival rates ranging from 9% to 45% in observational studies in this patient population. Patients with VF/pVT should be considered at the highest severity in the continuum of acute coronary syndromes. These patients have a significant burden of coronary artery disease and acute coronary thrombotic events. Evidence from randomized trials will further define optimal clinical practice.
• Böttiger, B. W., Lockey, A., Aickin, R., Castren, M., de Caen, A., Escalante, R., Kern, K. B., Lim, S. H., Nadkarni, V., Neumar, R. W., Nolan, J. P., Stanton, D., Wang, T. L., & Perkins, G. D. (2018). "All citizens of the world can save a life" - The World Restart a Heart (WRAH) initiative starts in 2018. Resuscitation, 128, 188-190.
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  "All citizens of the world can save a life". With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative - World Restart a Heart (WRAH) - to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by "first responders". Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR ("KIDS SAVE LIVES"), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.
• Dy, A., Lee, K. S., Srinivasan, S., Pineda, J. R., Lee, K. S., Koester, S., Kern, K. B., Dy, A., & Bhargava, R. (2018). TCT-826 Effect of Allura Xpef FD10 ECO X-Ray Image Processing on Radiation Reduction During Cardiac Catheterization: A Single Center 717 Case Experience. Journal of the American College of Cardiology, 72(13), B329-B330. doi:10.1016/j.jacc.2018.08.2066
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  The risks associated with exposure to ionizing radiation are well known. Novel strategies have been developed to minimize radiation to the patient and cath lab personnel. We present a retrospective analysis of predominantly radial coronary cases performed from February 2017 to May 2018 by a single
• Eubank, L., Lee, K. S., Seder, D. B., Strout, T., Darrow, M., MacDonald, C., May, T., Riker, R. R., & Kern, K. B. (2018). Approaches to community consultation in exception from informed consent: Analysis of scope, efficiency, and cost at two centers. Resuscitation, 130, 81-87.
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  Community consultation (CC) is fundamental to the Exception from Informed Consent (EFIC) process for emergency research, designed to inform and receive feedback from the target study population about potential risks and benefits. To better understand the effectiveness of different techniques for CC, we evaluated EFIC processes at two centers participating in a trial of early cardiac catheterization following out-of-hospital cardiac arrest.
• Lane, R. D., Reis, H. T., Hsu, C. H., Kern, K. B., Couderc, J. P., Moss, A. J., & Zareba, W. (2018). Abnormal Repolarization Duration During Everyday Emotional Arousal in Long QT Syndrome and Coronary Artery Disease. The American journal of medicine, 131(5), 565-572.e2.
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  Rare, high-arousal negative emotions are known triggers of sudden death in individuals with preexisting heart disease. Whether everyday fluctuations in emotional arousal influence arrhythmia risk is unknown.
• Lotun, K., & Kern, K. B. (2018). Interventional Cardiologist Approach to Cardiac Arrest. Current cardiology reviews, 14(2), 78.
• Mody, P., Brown, S. P., Kudenchuk, P. J., Chan, P. S., Khera, R., Ayers, C., Pandey, A., Kern, K., de Lemos, J. A., Link, M. S., & Idris, A. H. (2018). Intraosseous versus Intravenous access in Patients with Out-of-Hospital Cardiac Arrest: Insights from the Resuscitation Outcomes Consortium Continuous Chest Compression Trial. Resuscitation.
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  To examine outcomes associated with intraosseous access route attempt for delivery of medications during out-of-hospital cardiac arrest (OHCA) resuscitation.
• Rab, T., Ratanapo, S., Kern, K. B., Basir, M. B., McDaniel, M., Meraj, P., King, S. B., & O'Neill, W. (2018). Cardiac Shock Care Centers: JACC Review Topic of the Week. Journal of the American College of Cardiology, 72(16), 1972-1980.
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  Despite advances over the past decade, the incidence of cardiogenic shock secondary to acute myocardial infarction has increased, with an unchanged mortality near 50%. Recent trials have not clarified the best strategies in treatment. While dedicated cardiac shock centers are being established, there are no standardized agreements on the utilization of mechanical circulatory support and the timeliness of percutaneous coronary intervention strategies. In some centers and prospective registries, outcomes after placement of advanced mechanical circulatory support prior to reperfusion therapy with percutaneous coronary intervention have been encouraging with improved survival. Here, we suggest systems of care with a treatment pathway for patients with acute myocardial infarction complicated by cardiogenic shock.
• Rao, P., & Kern, K. B. (2018). Improving Community Survival Rates from Out-of-Hospital Cardiac Arrest. Current cardiology reviews, 14(2), 79-84.
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  Out of hospital cardiac arrest affects 350,000 Americans yearly and is associated with a high mortality rate. Improving survival rates in this population rests on the prompt and effective implementation of four key principles. These include 1) early recognition of cardiac arrest 2) early use of chest compressions 3) early defibrillation, which in turn emphasizes the importance of public access defibrillation programs and potential for drone technology to allow for early defibrillation in private or rural settings 4) early and aggressive post-arrest care including the consideration of therapeutic hypothermia, early coronary angiography +/- percutaneous coronary intervention and a hyper-invasive approach to out-of-hospital refractory cardiac arrest.
• Teachey, M. K., Querin, L., Piermarini, C. V., Mitchell, J. L., Krate, J., Kern, K. B., Hilwig, R. W., Heller, B. D., Gura, M., Dokken, B. B., Dameff, C., & Asghar, A. M. (2018). CORRIGENDUM.. American journal of physiology. Heart and circulatory physiology, 315(6), H1861. doi:10.1152/ajpheart.zh4-0651-corr.2018
• Bascom, K. E., Dziodzio, J., Vasaiwala, S., Mooney, M., Patel, N., McPherson, J., McMullan, P., Unger, B., Nielsen, N., Friberg, H., Riker, R. R., Kern, K. B., Duarte, C. W., Seder, D. B., & , I. C. (2017). Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients without STEMI after Cardiac Arrest. Circulation.
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  Background -No practical tool quantitates the risk of circulatory-etiology death (CED) immediately after successful cardiopulmonary resuscitation in patients without ST-elevation myocardial infarction (STEMI). We developed and validated a prediction model to rapidly determine that risk and facilitate triage to individualized treatment pathways. Methods -Using the International Cardiac Arrest Registry (INTCAR), an 87-question data set representing 44 centers in America and Europe, patients were classified as having had CED or a combined endpoint of neurological-etiology death or survival. Demographics and clinical factors were modeled in a derivation cohort, and backward stepwise logistic regression used to identify factors independently associated with CED. We demonstrated model performance using area under the curve (AUC) and the Hosmer Lemeshow test in the derivation and validation cohorts, and assigned a simplified point scoring system. Results -Among 638 patients in the derivation cohort, 121 (18.9%) had CED. The final model included preexisting Coronary artery disease (OR=2.86, CI 1.83-4.49, p=
• Beskind, D. L., Stolz, U., Thiede, R., Hoyer, R., Robertson, W., Brown, J., Ludgate, M., Tiutan, T., Shane, R., McMorrow, D., Pleasants, M., Kern, K. B., & Panchal, A. R. (2017). Viewing an ultra-brief chest compression only video improves some measures of bystander CPR performance and responsiveness at a mass gathering event. Resuscitation, 118, 96-100.
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  CPR training at mass gathering events is an important part of health initiatives to improve cardiac arrest survival. However, it is unclear whether training lay bystanders using an ultra-brief video at a mass gathering event improves CPR quality and responsiveness.
• Chaudhary, R., Garg, J., Krishnamoorthy, P., Bliden, K., Shah, N., Agarwal, N., Gupta, R., Sharma, A., Kern, K. B., Patel, N. C., & Gurbel, P. (2017). Erythropoietin therapy after out-of-hospital cardiac arrest: A systematic review and meta-analysis. World journal of cardiology, 9(12), 830-837.
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  To assess safety and efficacy of early erythropoietin (Epo) administration in patients with out-of-hospital cardiac arrest (OHCA).
• Kandala, J., Oommen, C., & Kern, K. B. (2017). Sudden cardiac death. British medical bulletin, 122(1), 5-15.
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  Sudden cardiac arrest continues to be the leading cause of death in the industrialized world.
• Lee, K. S., Yousman, W., Wong, W. X., Natarajan, B., Lee, K. S., Lee, J. Z., Kern, K. B., & Huang, J. J. (2017). CORONARY ANGIOGRAPHY SIMULATION TRAINING IMPROVES IMAGE INTERPRETATION SKILLS OF TRAINEES INDEPENDENT OF THEIR STAGE OF TRAINING. Journal of the American College of Cardiology, 69(11), 2522. doi:10.1016/s0735-1097(17)35911-9
• Neumar, R. W., Merchant, R. M., Kern, K. B., & Callaway, C. W. (2017). Balancing the Benefits and Risks of CPR.. The American journal of bioethics : AJOB, 17(2), 49-50. doi:10.1080/15265161.2016.1265174
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  The target article by Rosoff and Schneiderman (2017) raises the question of whether the training of laypersons to perform cardiopulmonary resuscitation (CPR) misrepresents the importance of laypers...
• Patel, N., Shah, N., Patel, N. C., Mehta, K., Kern, K. B., Jacobs, L. E., Garg, J., Freudenberger, R. S., Cox, D. A., Chaudhary, R., & Agarwal, V. (2017). Reply: Do We Need Individualized Therapeutic Strategies in High-Risk Patients Treated With Hypothermia?. JACC. Cardiovascular interventions, 10(1), 105-106. doi:10.1016/j.jcin.2016.11.015
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  We thank Dr. Jellinghaus and colleagues for their interest in our article [(1)][1]. We have read their commentary with great interest and would like to respond to the points raised by them. Dr. Jellinghaus and colleagues mention the potential impact of use of newer P2Y12 inhibitors such as
• Rao, P., Kern, K. B., & Harhash, A. (2017). The Role of Cardiac Catheterization after Cardiac Arrest. Cardiovascular Innovations and Applications, 3(2), 137-148. doi:10.15212/cvia.2017.0026
• Shetty, R., Hutchinson, M. D., Shetty, R., Reddy, S., Natarajan, B., Kern, K. B., Hutchinson, M. D., Huang-tsang, J., Harhash, A., & Balakrishnan, M. (2017). TCT-388 Does ST Segment Elevation in Lead aVR Correlate with Left Main Occlusion?. Journal of the American College of Cardiology, 70(18), B159. doi:10.1016/j.jacc.2017.09.484
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  Prompt identification of ST-elevation myocardial infarction (STEMI) on ECG is critical as early reperfusion can be lifesaving. The ACCF/AHA guidelines established that ST elevation (STE) must be present in at least 2 contiguous leads to qualify for a diagnosis of STEMI. STE in aVR, co-existent with
• Zuercher, M., & Kern, K. B. (2017). Reply: Should Early Coronary Angiography Be Performed in All Resuscitated Sudden Cardiac Arrests?. JACC. Cardiovascular interventions, 10(5), 535-536. doi:10.1016/j.jcin.2017.01.004
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  We appreciate the comments [(1)][1] from members of the Sudden Death Expertise Center in Paris, France. We certainly concur that patients without ST-segment elevation have a much lower rate of acute coronary occlusion than those manifesting ST-segment elevation. We have found in a nonrandomized,
• Kern, K. B., Hanna, J. M., Young, H. N., Ellingson, C. J., White, J. J., Heller, B., Illindala, U., Hsu, C., & Zuercher, M. (2016). Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post-Cardiac Arrest in a Porcine Model. JACC. Cardiovascular interventions.
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  The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest.
• Shah, N., Chaudhary, R., Mehta, K., Agarwal, V., Garg, J., Freudenberger, R., Jacobs, L., Cox, D., Kern, K. B., & Patel, N. (2016). Therapeutic Hypothermia and Stent Thrombosis: A Nationwide Analysis. JACC. Cardiovascular interventions, 9(17), 1801-11.
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  This study sought to determine whether "real-world" data supported the hypothesis that therapeutic hypothermia (TH) led to increased rates of stent thrombosis.
• Strout, T. D., Seder, D. B., Kern, K. B., & Eubank, L. (2016). 147: COMMUNITY CONSULTATION IN EXCEPTION FROM INFORMED CONSENT. Critical Care Medicine, 44, 114. doi:10.1097/01.ccm.0000508828.02941.96
• William, P., Rao, P., Kanakadandi, U. B., Asencio, A., & Kern, K. B. (2016). Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory. Circulation journal : official journal of the Japanese Circulation Society, 80(6), 1292-9.
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  Cardiac arrest, though not common during coronary angiography, is increasingly occurring in the catheterization laboratory because of the expanding complexity of percutaneous interventions (PCI) and the patient population being treated. Manual chest compression in the cath lab is not easily performed, often interrupted, and can result in the provider experiencing excessive radiation exposure. Mechanical cardiopulmonary resuscitation (CPR) provides unique advantages over manual performance of chest compression for treating cardiac arrest in the cardiac cath lab. Such advantages include the potential for uninterrupted chest compressions, less radiation exposure, better quality chest compressions, and less crowded conditions around the catheterization table, allowing more attention to ongoing PCI efforts during CPR. Out-of-hospital cardiac arrest patients not responding to standard ACLS therapy can be transported to the hospital while mechanical CPR is being performed to provide safe and continuous chest compressions en route. Once at the hospital, advanced circulatory support can be instituted during ongoing mechanical CPR. This article summarizes the epidemiology, pathophysiology and nature of cardiac arrest in the cardiac cath lab and discusses the mechanics of CPR and defibrillation in that setting. It also reviews the various types of mechanical CPR and their potential roles in and on the way to the laboratory. (Circ J 2016; 80: 1292-1299).
• Yang, L., Warren, S., Truitt, T. L., Stanton, E., Soar, J., Potts, J., Perman, S. M., Peberdy, M. A., Ornato, J. P., Nichol, G., Nadkarni, V. M., Mikkelsen, M. E., Merchant, R. M., Mancini, M. E., Mader, T., Kern, K. B., Hunt, E. A., Geocadin, R. G., Eigel, B., , Edelson, D. P., et al. (2016). Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes.. Journal of the American Heart Association, 5(10). doi:10.1161/jaha.116.003638
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  In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths..This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P
• Callaway, C. W., Donnino, M. W., Fink, E. L., Geocadin, R. G., Golan, E., Kern, K. B., Leary, M., Meurer, W. J., Peberdy, M. A., Thompson, T. M., & Zimmerman, J. L. (2015). Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132(18 Suppl 2), S465-S482.
• Derwall, M., Brücken, A., Bleilevens, C., Ebeling, A., Föhr, P., Rossaint, R., Kern, K. B., Nix, C., & Fries, M. (2015). Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study. Critical care (London, England), 19, 123.
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  Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA.
• Dokken, B. B., Gaballa, M. A., Hilwig, R. W., Berg, R. A., & Kern, K. B. (2015). Inhibition of nitric oxide synthases, but not inducible nitric oxide synthase, selectively worsens left ventricular function after successful resuscitation from cardiac arrest in swine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 22(2), 197-203.
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  Nitric oxide (NO) is a critical regulator of vascular tone and signal transduction in the cardiovascular system. NO is synthesized by three unique enzymes (nitric oxide synthases [NOS]): endothelial and neuronal NOS, both constitutively expressed, and inducible NOS (iNOS), which is induced by proinflammatory stimuli and subsequently produces a burst of NO. NO has been implicated as both an injurious and a beneficial mediator after cardiac arrest and resuscitation. A previous study in swine found that iNOS expression is absent in the myocardium prior to cardiac arrest and that it increases after 10 minutes of untreated ventricular fibrillation (VF), decreases somewhat during the early postresuscitation period, and then steadily increases up to 6 hours postresuscitation. Because this time course of iNOS expression mirrors that of postresuscitation myocardial dysfunction, this study was designed to test the hypothesis that selective inhibition of iNOS improves postresuscitation outcomes in swine.
• Ewy, G. A., Bobrow, B. J., Chikani, V., Sanders, A. B., Otto, C. W., Spaite, D. W., & Kern, K. B. (2015). The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest. Resuscitation, 96, 180-5.
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  Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial.
• Gianotto-Oliveira, R., Gonzalez, M. M., Vianna, C. B., Monteiro Alves, M., Timerman, S., Kalil Filho, R., & Kern, K. B. (2015). Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America. Journal of the American Heart Association, 4(10), e002185.
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  Targeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out-of-hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest.
• Indik, J. H., Conover, Z., McGovern, M., Silver, A. E., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2015). Amplitude-spectral area and chest compression release velocity independently predict hospital discharge and good neurological outcome in ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation, 92, 122-8.
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  In out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) the frequency-based waveform characteristic, amplitude-spectral area (AMSA) is associated with hospital discharge and good neurological outcome, yet AMSA is also known to increase in response to chest compressions (CC). In addition to rate and depth, well performed CC provides good chest recoil without leaning, reflected in the release velocity (RV). We hypothesized that AMSA is associated with hospital discharge and good neurological outcome independent of CC quality.
• Karlsson, V., Dankiewicz, J., Nielsen, N., Kern, K. B., Mooney, M. R., Riker, R. R., Rubertsson, S., Seder, D. B., Stammet, P., Sunde, K., Søreide, E., Unger, B. T., & Friberg, H. (2015). Association of gender to outcome after out-of-hospital cardiac arrest--a report from the International Cardiac Arrest Registry. Critical care (London, England), 19, 182.
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  Previous studies have suggested an effect of gender on outcome after out-of-hospital cardiac arrest (OHCA), but the results are conflicting. We aimed to investigate the association of gender to outcome, coronary angiography (CAG) and adverse events in OHCA survivors treated with mild induced hypothermia (MIH).
• Kern, K. B. (2015). Usefulness of cardiac arrest centers - extending lifesaving post-resuscitation therapies: the Arizona experience - .. Circulation journal : official journal of the Japanese Circulation Society, 79(6), 1156-63. doi:10.1253/circj.cj-15-0309
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  The post-cardiac arrest syndrome is a complex, multisystems response to the global ischemia and reperfusion injury that occurs with the onset of cardiac arrest, its treatment (cardiopulmonary resuscitation) and the re-establishment of spontaneous circulation. Regionalization of post-cardiac arrest care, utilizing specified cardiac arrest centers (CACs), has been proposed as the best solution to providing optimal care for those successfully resuscitated after out-of-hospital cardiac arrest. A multidisciplinary team of intensive care specialists, including critical care/pulmonologists, cardiologists (general, interventional, and electrophysiology), neurologists, and physical medicine/rehabilitation experts, is crucial for such centers. Particular attention to the timely initiation of targeted temperature management and early coronary angiography/percutaneous coronary intervention is best provided by such CACs. A State-wide program of CACs was started in Arizona in 2007. This is a voluntary program, whereby medical centers agree to provide all resuscitated cardiac arrest patients brought to their facility with state-of-the-art post-resuscitation care, including targeted temperature management for comatose patients and strong consideration for emergent coronary angiography for all patients with a likely cardiac etiology for their cardiac arrest. Survival improved by more than 50% at facilities that became CACs with a commitment to provide aggressive post-resuscitation care to all such patients. Providing aggressive, post-resuscitation care is the next real opportunity to increase long-term survival for cardiac arrest patients.
• Kern, K. B., & Kanakadandi, U. B. (2015). Out-of-hospital cardiac arrest: defining the role of coronary angiography and intervention.. Coronary artery disease, 26(7), 626-33. doi:10.1097/mca.0000000000000266
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  Targeted temperature management and early coronary angiography have become the standard of care for postcardiac arrest patients remaining comatose and with ST-segment elevation on the ECG. Less clear is the optimal approach for similar patients without ST-segment elevation on the postresuscitation ECG. However, current data from nonrandomized cohort studies suggest that many of these patients also benefit from an aggressive approach to postresuscitation care. Recent reports of increased stent thrombosis in the postarrest population need further exploration.
• Kern, K. B., Lotun, K., Patel, N., Mooney, M. R., Hollenbeck, R. D., McPherson, J. A., McMullan, P. W., Unger, B., Hsu, C., & Seder, D. B. (2015). Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography. JACC. Cardiovascular interventions, 8(8), 1031-40.
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  The aim of this study was to compare outcomes and coronary angiographic findings in post-cardiac arrest patients with and without ST-segment elevation myocardial infarction (STEMI).
• Lotun, K., & Kern, K. B. (2015). How Much Is Enough… What More Is Needed?. Circulation. Cardiovascular interventions, 8(10).
• Patel, N., Young, M., Unger, B. T., Seder, D. B., Patel, N. C., Nair, S., Mooney, M., Mcpherson, J., Kern, K. B., & Cash, M. E. (2015). RISK OF STENT THROMBOSIS IN CARDIAC ARREST PATIENTS WITH ST- ELEVATION MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION AND THERAPEUTIC HYPOTHERMIA: INTERNATIONAL CARDIAC ARREST REGISTRY. Journal of the American College of Cardiology, 65(10), A1888. doi:10.1016/s0735-1097(15)61888-5
• Rab, T., Kern, K. B., Tamis-Holland, J. E., Henry, T. D., McDaniel, M., Dickert, N. W., Cigarroa, J. E., Keadey, M., & Ramee, S. (2015). Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient. Journal of the American College of Cardiology, 66(1), 62-73.
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  Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
• Seder, D. B., Sunde, K., Rubertsson, S., Mooney, M., Stammet, P., Riker, R. R., Kern, K. B., Unger, B., Cronberg, T., Dziodzio, J., & Nielsen, N. (2015). Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Critical care medicine, 43(5), 965-72.
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  To evaluate the outcomes of cardiac arrest survivors with myoclonus receiving modern postresuscitation care.
• Truong, H., Low, L. S., & Kern, K. B. (2015). Current Approaches to Cardiopulmonary Resuscitation. Current problems in cardiology, 40(7), 275-313.
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  Real progress has been made in improving long-term outcome after out-of-hospital cardiac arrest in the past 10 years. Many communities have doubled their survival-to-hospital-discharge rate during this period. Common features of such successful programs include the following: (1) 911 dispatcher-assisted cardiopulmonary resuscitation (CPR) instruction, (2) bystander chest compression-only CPR program, (3) public access defibrillation, including targeted automated external defibrillator programs, (4) renewed emphasis on minimally interrupted chest compressions by emergency medical services responders, and (5) aggressive postresuscitation care, including targeted temperature management and early coronary angiography and intervention. An important lesson from these successful community efforts is that multiple, simultaneous changes to the local cardiac arrest response system are necessary to improve survival. The next exciting step in this quest appears to be the treatment of refractory cardiac arrest with the combination of mechanical CPR, intra-arrest hypothermia, extracorporeal CPR with mechanical circulatory support devices, and early coronary intervention.
• Low, L. S., & Kern, K. B. (2014). Importance of coronary artery disease in sudden cardiac death.. Journal of the American Heart Association, 3(5), e001339. doi:10.1161/jaha.114.001339
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  Ventricular arrhythmias, pulseless electrical activity, and asystole can occur at the early stages of an acute coronary thrombotic occlusion, causing hemodynamic collapse, and resulting in “sudden cardiac death.” Recognizing this common pathway for adult cardiac arrest, the 2012 European Society
• Bobrow, B. J., Stolz, U., Stolz, U., Stapczynski, J. S., Spaite, D. W., Mullins, T., Mullins, M., Kern, K. B., Humble, W., Ewy, G. A., Chikani, V., & Bobrow, B. J. (2012). System-wide Regionalization of EMS and Hospital Care for Out-of-Hospital Cardiac Arrest: Association with Improved Survival and Neurologic Outcomes. Resuscitation, 83, e19. doi:10.1016/j.resuscitation.2012.08.048
• Kern, K. B. (2012). Cardiac receiving centers: beyond hypothermia.. Current opinion in critical care, 18(3), 246-50. doi:10.1097/mcc.0b013e32835180d6
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  The role of cardiac arrest centers, more recently termed Cardiac Receiving Centers, in improving outcomes after successful resuscitation is becoming more and more convincing. But which of all the treatments provided by Cardiac Receiving Centers are most beneficial is less certain. This review examines the role of early coronary angiography and percutaneous coronary intervention in this regard..Cohort studies have consistently found that early coronary angiography is associated with improved long-term outcomes postcardiac arrest. The most common cause for out-of-hospital cardiac arrest is a myocardial ischemic event. Diagnosing and treating the underlying coronary trigger makes good physiological sense. The major issues are 'who' should undergo emergent coronary angiography and 'when' should it be done. Standard criteria such as ST segment elevation and precedent chest pains are not very sensitive in identifying those postcardiac arrest with an occluded or culprit lesion. As many as one in four postresuscitated patients without ST elevation have a significant culprit lesion, including at times an acutely occluded coronary. Cardiac Receiving Centers should have the capacity to perform emergent coronary angiography on every resuscitated patient who does not have an obvious noncardiac cause for their arrest..Emergent coronary angiography and percutaneous coronary intervention are the most important Cardiac Receiving Center treatments beyond hypothermia. Providing both of these essential postresuscitation therapies is the very purpose of such centers.
• Sugumaran, R. K., Murdock, E., Kumar, S., & Kern, K. B. (2012). The role of emergency coronary intervention during and following cardiopulmonary resuscitation.. Critical care clinics, 28(2), 283-97. doi:10.1016/j.ccc.2011.10.011
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  The vast majority of patients with out-of-hospital cardiac arrest have underlying coronary artery disease. Autopsy studies have documented an 80% to 90% incidence of significant coronary disease in adults succumbing to sudden cardiac death. Prospective studies of coronary angiography of those successfully resuscitated also show an incidence of coronary disease approaching 80%. Acute coronary ischemia s a common trigger for out-of-hospital ventricular fibrillation cardiac arrest. Culprit esions can be readily identified during coronary angiography immediately after esuscitation in 90% of those with ST elevation myocardial infarction (STEMI) and in 5% of those without STEMI.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., Simoons, M. L., Chaitman, B. R., White, H. D., Katus, H. A., Apple, F. S., Lindahl, B., Morrow, D. A., Chaitman, B. A., Clemmensen, P. M., Johanson, P., Hod, H., Underwood, R., Bax, J. J., Bonow, R. O., Pinto, F., Gibbons, R. J., , Fox, K. A., et al. (2012). Third universal definition of myocardial infarction.. European heart journal, 33(20), 2551-67. doi:10.1093/eurheartj/ehs184
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  ACCF : American College of Cardiology Foundation ACS : acute coronary syndrome AHA : American Heart Association CAD : coronary artery disease CABG : coronary artery bypass grafting CKMB : creatine kinase MB isoform cTn : cardiac troponin CT : computed tomography CV : coefficient of variation ECG : electrocardiogram ESC : European Society of Cardiology FDG : fluorodeoxyglucose h : hour(s) HF : heart failure LBBB : left bundle branch block LV : left ventricle LVH : left ventricular hypertrophy MI : myocardial infarction mIBG : meta-iodo-benzylguanidine min : minute(s) MONICA : Multinational MONItoring of trends and determinants in CArdiovascular disease) MPS : myocardial perfusion scintigraphy MRI : magnetic resonance imaging mV : millivolt(s) ng/L : nanogram(s) per litre Non-Q MI : non-Q wave myocardial infarction NSTEMI : non-ST-elevation myocardial infarction PCI : percutaneous coronary intervention PET : positron emission tomography pg/mL : pictogram(s) per millilitre Q wave MI : Q wave myocardial infarction RBBB : right bundle branch block sec : second(s) SPECT : single photon emission computed tomography STEMI : ST elevation myocardial infarction ST–T : ST-segment –T wave URL : upper reference limit WHF : World Heart Federation WHO : World Health Organization Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that …
• Zuercher, M., Nysaether, J., Nadkarni, V. M., Kern, K. B., Hilwig, R. W., Gura, M., Berg, R. A., & Berg, M. D. (2012). Corrigendum to “A sternal accelerometer does not impair hemodynamics during piglet CPR” [Resuscitation 82 (9) (2011) 1231–1234]. Resuscitation, 83(2), 270. doi:10.1016/j.resuscitation.2011.08.002
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  The University of Arizona Sarver Heart Center, Tucson, AZ, United States Department of Anesthesia and Intensive Care Medicine, University Hospital Basel, Switzerland Laerdal Medical Corporation, Stavanger, Norway Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States University of Arizona College of Medicine Steele Children’s Research Center and Department of Pediatrics, Tucson, AZ, United States Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
• Kern, K. B. (2011). 'Cooling and cathing' the post-resuscitated.. Critical care (London, England), 15(4), 178. doi:10.1186/cc10299
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  Cronier and co-workers provide additional evidence that routine use of mild therapeutic hypothermia combined with emergent coronary angiography and percutaneous intervention results in excellent survival with intact neurological function for post-resuscitation patients with ventricular fibrillation.
• Kern, K. B. (2011). Encouraging (not discouraging) optimal care for all ST-segment elevation myocardial infarction patients.. JACC. Cardiovascular interventions, 4(4), 449-51. doi:10.1016/j.jcin.2011.02.002
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  In this issue of JACC: Cardiovascular Interventions , Ellis et al. ([1][1]) present an enhanced ST-segment elevation myocardial infarction (STEMI) risk adjustment algorithm that better accounts for noncardiac causes of mortality after primary percutaneous intervention. The investigators note that in
• Kern, K. B. (2011). Importance of invasive interventional strategies in resuscitated patients following sudden cardiac arrest. Interventional Cardiology, 3(6), 649-661. doi:10.2217/ica.11.79
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  Post-resuscitation care has become a major part of the chain of survival for victims of cardiac arrest. Once spontaneous circulation is restored, it is important to consider early coronary angiography and concurrent use of mild therapeutic hypothermia. In those resuscitated from an arrest considered to be cardiac in origin, coronary angiography should be performed inmmediately to identify any culprit coronary occlusion or unstable lesions. If a culprit lesion is found, immediate percutaneous coronary intervention should be performed. Any out-of-hospital cardiac arrest victim successfully resuscitated, but who remain comatose after return of spontaneous circulation, should be cooled to 32–24°C for 24 h. Induction of mild hypothermia can be accomplished without delaying coronary intervention. When these two post-resuscitation therapies are provided concurrently long-term survival is 50–60%, with favorable neurological function achieved in 80–90% of such survivors.
• Kern, K. B., & Ewy, G. A. (2011). A non-guidelines approach to cardiocerebral resuscitation. Journal of Paramedic Practice, 3(12), 682-689. doi:10.12968/jpar.2011.3.12.682
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  Cardiovascular disease is a leading cause of death in most Western industrialized nations, making out-of-hospital cardiac arrest (OHCA) a major public health problem (Atwood et al, 2005; Lloyd-Jones, 2010). Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often sudden cardiac arrest (Roger et al, 2011). It is not just a problem of the elderly as the average decade of adults with OHCA is the sixth (Bobrow et al, 2010). In the US, a 40 year-old-male has a 1 in 8 chance of dying from cardiac arrest (Lloyd-Jones, 2010). This article will present a non-guidelines approach to the management of patients with primary OHCA that significantly improves survival. It is called ‘cardiocerebral resuscitation’ as it limits interruptions of blood flow to the heart and the brain by emphasizing near continuous chest compressions not only by bystanders but also by advanced life support (ALS) providers. It deemphasizes assisted ventilation, as patients with primary cardiac arrest...
• Kern, K. B., Indik, J. H., Hilwig, R. W., Gura, M., Dameff, C., & Allen, D. (2011). IN A SWINE MODEL OF VF CARDIAC ARREST THE VF WAVEFORM PREDICTS A RETURN OF SPONTANEOUS CIRCULATION AND CAN DISTINGUISH AN ACUTE FROM POST MYOCARDIAL INFARCTION STATE. Journal of the American College of Cardiology, 57(14), E1132. doi:10.1016/s0735-1097(11)61132-7
• Kern, K. B., Timerman, S., Gonzalez, M. M., & Ramires, J. A. (2011). Optimized approach in cardiocerebral resuscitation. Arquivos brasileiros de cardiologia, 96(4), e77-80.
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  Cardiocerebral Resuscitation (CCR) is a new approach to the resuscitation of patients with out-of-hospital cardiac arrest (OHCA). The first major component of CCR is continuous chest compressions (also referred to as chest compression-only CPR or "hands-only CPR") advocated as part of CCR for all bystanders who witness a sudden collapse of presumed cardiac origin. The second component of CCR is a new ACLS treatment algorithm for Emergency Medical Services. This algorithm emphasizes uninterrupted chest compressions regardless of other ongoing assignments as part of the rescue effort. A third component has recently been added to CCR, namely aggressive post-resuscitation care. Cardiocerebral resuscitation has increased bystander participation and has improved survival rates in a number of communities. Now is the time for other communities to re-examine their own outcomes with cardiac arrest and consider joining those cities and communities that have doubled and even tripled their survival from OHCA.
• Sanders, A. B., Kern, K. B., & Ewy, G. A. (2011). Compression-only cardiopulmonary resuscitation improves survival.. The American journal of medicine, 124(5), 383-5. doi:10.1016/j.amjmed.2010.09.024
• Timerman, S., Ramires, J. A., & Kern, K. B. (2011). The new consensus on cardiopulmonary resuscitation and emergency cardiovascular care-cardiocerebral resuscitation. US Cardiology Review, 8(1), 35-38. doi:10.15420/usc.2011.8.1.35
• Zia, A., & Kern, K. B. (2011). Management of postcardiac arrest myocardial dysfunction.. Current opinion in critical care, 17(3), 241-6. doi:10.1097/mcc.0b013e3283447759
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  Recent recognition of the importance of postresuscitation care has stimulated interest and new reports concerning therapies for postcardiac arrest myocardial dysfunction. Such cardiac dysfunction after successful resuscitation can be severe and even lethal; however, it is also transient emphasizing the importance of early supportive therapies..The most important strategies for dealing with postresuscitation myocardial dysfunction include a community-formalized effort by individual communities to shorten the time from arrest to restoration of spontaneous circulation, use of therapeutic hypothermia for myocardial preservation, not just cerebral, and early coronary angiography and intervention for all survivors with a high suspicion of a cardiac cause for their arrest. Exciting specific therapies targeted for one or another of the ischemia/reperfusion myocardial injuries associated with cardiac arrest include manipulation of the nitric oxide production in the myocardium, treatment of myocardial microcirculatory dysfunction post resuscitation, inhibition of Na+/H+ exchange, and treatment of calcium flux abnormalities..Every community should be striving to provide more timely restoration of pulse and circulation, whereas every medical center receiving patients resuscitated from out-of-hospital cardiac arrest should be providing therapeutic hypothermia for both central nervous system and myocardial preservation. The ability and commitment to provide '24/7' early coronary angiography and percutaneous intervention for all resuscitated victims of sudden cardiac death with a likely cardiac cause for their arrest is also key.
• Zuercher, M., Kern, K. B., Indik, J. H., Loedl, M., Hilwig, R. W., Ummenhofer, W., Berg, R. A., & Ewy, G. A. (2011). Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. Anesthesia and analgesia, 112(4), 884-90.
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  Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine.
• Bobrow, B. J., Stolz, U., Vadeboncoeur, T. F., Stolz, U., Stapczynski, J. S., Spaite, D. W., Sanders, A. B., Mullins, T. J., Lovecchio, F., Kern, K. B., Humble, W. O., Gallagher, J. V., Ewy, G. A., Clark, L. L., Bobrow, B. J., & Berg, R. A. (2010). Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest.. JAMA, 304(13), 1447-54. doi:10.1001/jama.2010.1392
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  Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest..To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR..A 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression..Survival to hospital discharge..Among 5272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded because bystander CPR was provided by a health care professional or the arrest occurred in a medical facility. A total of 4415 met all inclusion criteria for analysis, including 2900 who received no bystander CPR, 666 who received conventional CPR, and 849 who received COCPR. Rates of survival to hospital discharge were 5.2% (95% confidence interval [CI], 4.4%-6.0%) for the no bystander CPR group, 7.8% (95% CI, 5.8%-9.8%) for conventional CPR, and 13.3% (95% CI, 11.0%-15.6%) for COCPR. The adjusted odds ratio (AOR) for survival for conventional CPR vs no CPR was 0.99 (95% CI, 0.69-1.43), for COCPR vs no CPR, 1.59 (95% CI, 1.18-2.13), and for COCPR vs conventional CPR, 1.60 (95% CI, 1.08-2.35). From 2005 to 2009, lay rescuer CPR increased from 28.2% (95% CI, 24.6%-31.8%) to 39.9% (95% CI, 36.8%-42.9%; P < .001); the proportion of CPR that was COCPR increased from 19.6% (95% CI, 13.6%-25.7%) to 75.9% (95% CI, 71.7%-80.1%; P < .001). Overall survival increased from 3.7% (95% CI, 2.2%-5.2%) to 9.8% (95% CI, 8.0%-11.6%; P < .001)..Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression-only CPR.
• Indik, J. H., Allen, D., Shanmugasundaram, M., Zuercher, M., Hilwig, R. W., Berg, R. A., & Kern, K. B. (2010). Predictors of resuscitation in a swine model of ischemic and nonischemic ventricular fibrillation cardiac arrest: superiority of amplitude spectral area and slope to predict a return of spontaneous circulation when resuscitation efforts are prolonged. Critical care medicine, 38(12), 2352-7.
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  We have demonstrated that a return of spontaneous circulation in the first 3 mins of resuscitation in swine is predicted by ventricular fibrillation waveform (amplitude spectral area or slope) when untreated ventricular fibrillation duration or presence of acute myocardial infarction is unknown. We hypothesized that in prolonged resuscitation efforts that return of spontaneous circulation immediately after a second or later shock with postshock chest compression is independently predicted by end-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform measured before that shock in a swine model of ischemic and nonischemic ventricular fibrillation arrest.
• Nadkarni, V. M., Meaney, P. A., Kern, K. B., Indik, J. H., Halperin, H. R., & Berg, R. A. (2010). The problem of delayed inhospital defibrillation is obscured by poor time-interval data. Critical Care Medicine, 38(6), 1500. doi:10.1097/ccm.0b013e3181dd0983
• Teachey, M. K., Piermarini, C. V., Meininger, C. J., Kern, K. B., Hilwig, R. W., Gura, M., Dokken, B. B., & Dameff, C. J. (2010). Glucagon-like Peptide-1 Enhances Nitric Oxide Production by Coronary Endothelial Cells and improves Endothelium-dependent Coronary Microvascular Function after Cardiac Arrest and Resuscitation. Free Radical Biology and Medicine, 49, S20. doi:10.1016/j.freeradbiomed.2010.10.022
• Bobrow, B. J., Kern, K. B., & Bobrow, B. J. (2009). Regionalization of postcardiac arrest care.. Current opinion in critical care, 15(3), 221-7. doi:10.1097/mcc.0b013e328329c293
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  To discuss the concept and implementation of regionalized postcardiac arrest care..American Heart Association guidelines call for therapeutic hypothermia in patients who have return of spontaneous circulation but remain comatose after out-of-hospital cardiac arrest due to ventricular fibrillation. The real and perceived technical challenges of inducing, maintaining, and monitoring postarrest patients who have received induced hypothermia have limited its widespread use. In addition, recent data suggest that emergency primary coronary intervention may benefit those victims of out-of-hospital cardiac arrest with return of spontaneous circulation. However, most community hospitals lack consistent 24-h a day emergency percutaneous coronary intervention capability. Therefore, despite showing efficacy in clinical trials, these therapies remain underutilized in clinical practice, thus limiting their widespread use. The concept of regionalized specialty care has been used successfully for other time-sensitive illnesses such as major trauma and acute stroke. Evidence extrapolated from the trauma and stroke literature suggests that such a system of care would be well tolerated, feasible, and would improve outcomes after out-of-hospital cardiac arrest..It is feasible to implement a large system of care in which eligible postcardiac patients are triaged to centers capable of delivering standardized, state-of-the art postarrest care. Further research is warranted to determine the optimal design of such a system of care.
• Kern, K. B., & Ewy, G. A. (2009). Recent advances in cardiopulmonary resuscitation: cardiocerebral resuscitation.. Journal of the American College of Cardiology, 53(2), 149-57. doi:10.1016/j.jacc.2008.05.066
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  Cardiocerebral resuscitation (CCR) is a new approach for resuscitation of patients with cardiac arrest. It is composed of 3 components: 1) continuous chest compressions for bystander resuscitation; 2) a new emergency medical services (EMS) algorithm; and 3) aggressive post-resuscitation care. The first 2 components of CCR were first instituted in 2003 in Tucson, Arizona; in 2004 in the Rock and Walworth counties of Wisconsin; and in 2005 in the Phoenix, Arizona, metropolitan area. The CCR method has been shown to dramatically improve survival in the subset of patients most likely to survive: those with witnessed arrest and shockable rhythm on arrival of EMS. The CCR method advocates continuous chest compressions without mouth-to-mouth ventilations for witnessed cardiac arrest. It advocates either prompt or delayed defibrillation, based on the 3-phase time-sensitive model of ventricular fibrillation (VF) articulated by Weisfeldt and Becker. For bystanders with access to automated external defibrillators and EMS personnel who arrive during the electrical phase (i.e., the first 4 or 5 min of VF arrest), the delivery of prompt defibrillator shock is recommended. However, EMS personnel most often arrive after the electrical phase -- in the circulatory phase of VF arrest. During the circulatory phase of VF arrest, the fibrillating myocardium has used up much of its energy stores, and chest compressions that perfuse the heart are mandatory prior to and immediately after a defibrillator shock. Endotracheal intubation is delayed, excessive ventilations are avoided, and early-administration epinephrine is advocated.
• Shanmugasundaram, M., Indik, J. H., Kern, K. B., Allen, D., Hilwig, R. W., & Berg, R. (2009). Predictors of resuscitation in a swine model of VF cardiac arrest: superiority of amplitude spectral area (AMSA) to predict a return of spontaneous circulation when resuscitation efforts are prolonged. Circulation, 120(supplemental), S 671.
• Sorrell, V. L., Kern, K. B., Kalra, N., Hilwig, R. W., Ewy, G. A., & Berg, R. A. (2009). Mild Hypothermia Delays the Evolution of Early LV Dilatation and Late Stone Heart from Untreated Sustained Ventricular Fibrillation. Journal of Cardiac Failure, 15(6), S12. doi:10.1016/j.cardfail.2009.06.349
• Bobrow, B. J., Zuercher, M., Ewy, G. A., Clark, L., Chikani, V., Donahue, D., Sanders, A. B., Hilwig, R. W., Berg, R. A., & Kern, K. B. (2008). Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation, 118(24), 2550-4.
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  The incidence and significance of gasping after cardiac arrest in humans are controversial.
• Zuercher, M., Sanders, A. B., Otto, C. W., Kern, K. B., Hilwig, R. W., Hayes, M. M., Ewy, G. A., & Berg, R. A. (2008). Response to Letter Regarding Article “Improved Neurological Outcome With Continuous Chest Compressions Compared With 30:2 Compressions-to-Ventilations Cardiopulmonary Resuscitation in a Realistic Swine Model of Out-of-Hospital Cardiac Arrest”. Circulation, 117(24). doi:10.1161/circulationaha.108.772202
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  We are pleased to be able to respond to the concerns about chest compressions without ventilations for victims of out-of-hospital cardiac arrest expressed by Rottenberg and the relevance of our swine model to patients. Similar concerns by others are in part the reason why continuous-chest-compression cardiopulmonary resuscitation (CCC CPR) has not as yet been included in Guidelines. As Rottenberg noted, in humans, the tongue, soft palate, and/or the epiglottis may act as a 1-way valve. This may result in partial obstruction, but it does not prevent the gasping effort. In fact, this …
• Bobrow, B. J., Vadeboncoeur, T. F., Shimmin, S., Sanders, A. B., Richman, P. B., Kern, K. B., Clark, L., & Bobrow, B. J. (2007). 197: Witnessed Arrest With Bystander-Initiated Cardiopulmonary Resuscitation Increases the Incidence of Ventricular Fibrillation Found by First Responders. Annals of Emergency Medicine, 50(3), S62-S63. doi:10.1016/j.annemergmed.2007.06.349
• Ewy, G. A., Zuercher, M., Hilwig, R. W., Sanders, A. B., Berg, R. A., Otto, C. W., Hayes, M. M., & Kern, K. B. (2007). Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation, 116(22), 2525-30.
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  The 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care changed the previous ventilations-to-chest-compression algorithm for bystander cardiopulmonary resuscitation (CPR) from 2 ventilations before each 15 chest compressions (2:15 CPR) to 30 chest compressions before 2 ventilations (30:2 CPR). It was acknowledged in the guidelines that the change was based on a consensus rather than clear evidence. This study was designed to compare 24-hour neurologically normal survival between the initial applications of continuous chest compressions without assisted ventilations with 30:2 CPR in a swine model of witnessed out-of-hospital ventricular fibrillation cardiac arrest.
• Hayes, M. M., Ewy, G. A., Anavy, N. D., Hilwig, R. W., Sanders, A. B., Berg, R. A., Otto, C. W., & Kern, K. B. (2007). Continuous passive oxygen insufflation results in a similar outcome to positive pressure ventilation in a swine model of out-of-hospital ventricular fibrillation. Resuscitation, 74(2), 357-65.
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  The deleterious effects of positive pressure ventilation may be prevented by substituting passive oxygen insufflation during advanced cardiac life support (ACLS) cardiopulmonary resuscitation (CPR).
• Indik, J. H., Donnerstein, R. L., Berg, R. A., Hilwig, R. W., Berg, M. D., & Kern, K. B. (2007). Ventricular fibrillation frequency characteristics are altered in acute myocardial infarction. Critical care medicine, 35(4), 1133-8.
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  Future automated external defibrillators are being designed to direct rescue efforts (chest compressions first vs. defibrillation) by inferring the duration of ventricular fibrillation based on its waveform characteristics such as frequency content. This approach assumes that the ventricular fibrillation waveform is an appropriate surrogate for ventricular fibrillation duration and is not affected by structural heart disease. We hypothesized that an acute myocardial infarction may alter the frequency content of ventricular fibrillation.
• Moretti, M. A., Cesar, L. A., Nusbacher, A., Kern, K. B., Timerman, S., & Ramires, J. A. (2007). Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation, 72(3), 458-65.
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  Advanced cardiac life support (ACLS) training was introduced to bring order and a systematic approach to the treatment of cardiac arrest by professional responders. In spite of the wide dissemination of ACLS training, it has been difficult to demonstrate improved outcome following such training.
• Sorrell, V. L., Bhatt, R. D., Berg, R. A., Squire, S., Kudithipudi, V., Hilwig, R. W., Altbach, M. I., Kern, K. B., & Ewy, G. A. (2007). Cardiac magnetic resonance imaging investigation of sustained ventricular fibrillation in a swine model--with a focus on the electrical phase. Resuscitation, 73(2), 279-86.
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  We sought to develop a method to evaluate the rapidly changing cardiac dimensions during sustained ventricular fibrillation (VF). We also present details of our CPR research imaging program to facilitate this avenue of clinically important research.
• Heidenreich, J. W., Berg, R. A., Higdon, T. A., Ewy, G. A., Kern, K. B., & Sanders, A. B. (2006). Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 13(10), 1020-6.
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  Continuous chest-compression cardiopulmonary resuscitation (CCC-CPR) has been advocated as an alternative to standard CPR (STD-CPR). Studies have shown that CCC-CPR delivers substantially more chest compressions per minute and is easier to remember and perform than STD-CPR. One concern regarding CCC-CPR is that the rescuer may fatigue and be unable to maintain adequate compression rate or depth throughout an average emergency medical services response time. The specific aim of this study was to compare the effects of fatigue on the performance of CCC-CPR and STD-CPR on a manikin model.
• Higdon, T. A., Heidenreich, J. W., Kern, K. B., Sanders, A. B., Berg, R. A., Hilwig, R. W., Clark, L. L., & Ewy, G. A. (2006). Single rescuer cardiopulmonary resuscitation: can anyone perform to the guidelines 2000 recommendations?. Resuscitation, 71(1), 34-9.
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  The Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend that for adult cardiac arrest the single rescuer performs "two quick breaths followed by 15 chest compressions." This cycle is continued until additional help arrives. Previous studies have shown that lay persons and medical students take 16 +/- 1 and 14 +/- 1 s, respectively, to perform these "two quick breaths." The purpose of this study was to determine the time required for trained professional paramedic firefighters to deliver these two breaths and the effects that any increase in the time it takes to perform rescue breathing would have on the number of chest compressions delivered during single rescuer BLS CPR. We hypothesized that trained professional rescuers would also take substantially longer then the Guidelines recommendation for delivering the two rescue breaths before every 15 compressions during simulated single rescuer BLS CPR.
• Indik, J. H., Donnerstein, R. L., Kern, K. B., Goldman, S., Gaballa, M. A., & Berg, R. A. (2006). Ventricular fibrillation waveform characteristics are different in ischemic heart failure compared with structurally normal hearts. Resuscitation, 69(3), 471-7.
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  For prolonged VF, perfusion of the myocardium by pre-shock chest compressions can improve myocardial readiness for successful defibrillation. Characteristics of the VF waveform correlate with the duration of VF when there is no structural heart disease. A "smart" automated external defibrillator (AED) could therefore analyze the VF waveform, determine if VF has been prolonged, and then direct rescuers to either deliver a shock first or chest compressions first. We hypothesized that ischemic heart failure might alter the waveform content of ventricular fibrillation compared with normal hearts, complicating the determination of VF duration.
• Valenzuela, T. D., Kern, K. B., Clark, L. L., Berg, R. A., Berg, M. D., Berg, D. D., Hilwig, R. W., Otto, C. W., Newburn, D., & Ewy, G. A. (2005). Interruptions of chest compressions during emergency medical systems resuscitation. Circulation, 112(9), 1259-65.
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  Survival after nontraumatic out-of-hospital (OOH) cardiac arrest in Tucson, Arizona, has been flat at 6% (121/2177) for the decade 1992 to 2001. We hypothesized that interruptions of chest compressions occur commonly and for substantial periods during treatment of OOH cardiac arrest and could be contributing to the lack of improvement in resuscitation outcome.
• Berg, R. A., Hilwig, R. W., Kern, K. B., Sanders, A. B., Xavier, L. C., & Ewy, G. A. (2003). Automated external defibrillation versus manual defibrillation for prolonged ventricular fibrillation: lethal delays of chest compressions before and after countershocks. Annals of emergency medicine, 42(4), 458-67.
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  We sought to determine whether the delays in chest compressions and defibrillation associated with an automated external defibrillator would adversely affect outcome compared with manual defibrillation in a swine model of out-of-hospital prolonged ventricular fibrillation.
• Xavier, L., Kern, K. B., Berg, R. A., Hilwig, R. W., & Ewy, G. A. (2003). Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model. Resuscitation, 59(3), 337-44.
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  Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an innovative basic life support technique requiring no mechanical adjuncts. Optimizing its performance remains a challenge. Hand-position technique over the abdomen during interposed abdominal compression (IAC) may be important. The purpose of this study was to determine if there is a difference in efficacy depending on the type of abdominal hand-position used. Two different hand positions were studied: open hands, placed side by side, resulting in diffuse abdominal compression and stacked hands, with one on top of the other, producing a more focal compression of the abdomen. Thirty swine were cannulated with micromanometer-tipped pressure transducers in the ascending aorta (Ao) and right atrium (RA), and Millar Doppler-tipped catheters in the descending aorta and inferior vena cava (IVC) to determine flow patterns during cardiopulmonary resuscitation (CPR), During CPR there were no differences in aortic systolic or right atrial systolic pressures. Both forms of IAC-CPR produced greater aortic diastolic and right atrial diastolic pressures then standard CPR (STD-CPR) (P
• Babar, S. I., Berg, R. A., Hilwig, R. W., Kern, K. B., & Ewy, G. A. (1999). Vasopressin versus epinephrine during cardiopulmonary resuscitation: a randomized swine outcome study. Resuscitation, 41(2), 185-92.
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  In animal models, vasopressin improves short-term outcome after cardiopulmonary resuscitation (CPR) for ventricular fibrillation compared to placebo, and improves myocardial and cerebral hemodynamics during CPR compared to epinephrine. This study was designed to test the hypothesis that vasopressin would improve 24-h neurologically intact survival compared to epinephrine. After a 2-min untreated ventricular fibrillation interval followed by 6 min of simulated bystander CPR, 35 domestic swine (weight, 25+/-1 kg) were randomly provided with a single dose of vasopressin (20 U or approximately 0.8 U kg(-1) intravenously) or with epinephrine (0.02 mg kg(-1) intravenously every 5 min). Ten minutes after initial medication administration (18 min after induction of ventricular fibrillation), standard advanced life support was provided, starting with defibrillation. Animals that were successfully resuscitated received 1 h of intensive care support and were observed for 24 h. Coronary perfusion pressures were higher in the vasopressin group 2 and 4 min after vasopressin administration (28+/-2 versus 18+/-1 mm Hg, P
• Kern, K. B., & Fenster, P. E. (1992). Evaluation of cardiomyoplasty and skeletal muscle ventricle procedures in a clinically realistic animal model. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 11(5), S328-33.
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  Cardiomyoplasty and skeletal muscle ventricle procedures have shown increasing promise in the treatment of cardiomyopathy with associated chronic congestive heart failure. More than 100 patients have now received such procedures worldwide. The clinical results to date have been mostly anecdotal with subjective improvement but without firm objective data to collaborate the subjective impression. A clinically realistic animal model would have tremendous advantages to help elucidate the mechanisms by which cardiomyoplasty or skeletal muscle ventricles improve the sense of well-being of patients who have congestive heart failure. Several possible animal models exist, including pharmacologically induced congestive heart failure models and postischemic injury cardiomyopathy models. The most intriguing, however, is a spontaneously occurring cardiomyopathy in large dogs. This idiopathic cardiomyopathy that appears mainly in large-breed dogs (Great Danes, Dobermans, and Saint Bernards) has a rapidly progressive course; it has a 6-month mortality rate of 75% and a 12-month mortality rate of 95% to 100%. The most efficacious use of such an experimental model would include the evaluation of cardiomyoplasty and skeletal muscle ventricle procedures in a multidimensional fashion. Experimental endpoints should include mortality, exercise tolerance, systolic and diastolic ventricular function, and arrhythmia occurrence. Sophisticated techniques now exist for the evaluation of systolic and diastolic ventricular function. Such evaluation may well provide additional insight into how such experimental procedures benefit those with congestive heart failure.
• Kern, K. B., Nelson, J. R., Norman, S. A., Milander, M. M., & Hilwig, R. W. (1992). Oxygenation and ventilation during cardiopulmonary resuscitation utilizing continuous oxygen delivery via a modified pharyngeal-tracheal lumened airway. Chest, 101(2), 522-9.
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  Use of continuous transtracheal oxygen delivery systems combined with rhythmic chest compressions can provide excellent oxygenation and ventilation during cardiopulmonary resuscitation. However, occasional displacement of the transtracheal catheter results in life-threatening pneumomediastinal complications. We investigated using the pharyngeal lumen of a pharyngeal-tracheal lumened airway (PtL) as an alternative delivery system for continuous oxygen flow in 21 large mongrel dogs. Excellent ventilation was possible in anesthetized, apneic, and paralyzed dogs in normal sinus rhythm from the "bellows" effect of chest compressions. The hypercapnia and respiratory acidemia resulting from 5 min of complete apnea in ten dogs during normal sinus rhythm was readily corrected (p less than 0.01). In an additional 11 dogs, external chest compressions were performed and oxygen was delivered continuously via the PtL during 20 min of ventricular fibrillation. During this period of cardiac arrest, pH declined (7.38 +/- 0.01 vs 7.19 +/- 0.02; p less than 0.01), but PaCO2 (35 +/- 1 vs 38 +/- 3 mm Hg) and PaO2 (67 +/- 2 vs 68 +/- 3 mm Hg) were not significantly different from prearrest values. Successful resuscitation was achieved in 8 of 11 (73 percent) animals, which is similar to the results in historical controls with endotracheal intubation. No pneumomediastinal complications were seen with use of the PtL. We conclude that using the pharyngeal lumen of the PtL for continuous delivery of oxygen combined with external chest compressions can provide a safe and effective mode of oxygenation and ventilation during cardiac arrest.
• Branditz, F. K., Kern, K. B., & Campbell, S. C. (1989). Continuous transtracheal oxygen delivery during cardiopulmonary resuscitation. An alternative method of ventilation in a canine model. Chest, 95(2), 441-8.
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  Adequate oxygenation of apneic subjects can be maintained by constant flow transtracheal oxygen (TTO), but this method alone is associated with hypercapnia. The "bellows" effect of external chest compressions (ECC) might prevent this problem if the airway were kept open by TTO. In dogs, we investigated the utility of TTO delivered at 15 L/min by a percutaneously placed intratracheal catheter, plus ECC (TTO/ECC) as an alternative method of ventilation during CPR. TTO was applied to anesthetized, paralyzed dogs in normal sinus rhythm (NSR) at various rates of ECC and during ventricular fibrillation (VF) at an ECC rate of 80/min. During NSR and VF, hypercapnia did not develop and arterial oxygen saturations were maintained above 90 percent. During NSR, the PaCO2 decreased and the pH increased as the ECC rate increased. For many of the animals, coronary perfusion pressure remained above 20 mm Hg during VF, suggesting that these animals could be resuscitated to NSR. In another phase, after 15 min of VF using TTO/ECC, seven of nine animals were defibrillated. We conclude that ventilatory and hemodynamic support adequate to permit successful resuscitation to NSR is provided by the combination of TTO/ECC to apneic dogs during VF.

Presentations

• Kern, K. B. (2017, April). Contemporary Protocols in Arrest and Shock (2017). EPIC-SEC (Emory Practical Intervention Course-Southeastern consortium) 2017. Atlanta, GA.
• Kern, K. B. (2017, August). Improving Community Response to Cardiac Arrest in 2017. Grand Rounds at Northeast Georgia Medical Center. Gainesville, GA.
• Kern, K. B. (2017, February). Making Tucson Safer Through CPR Innovations. University of Arizona ‘Olli’ program. Tucson, AZ.
• Kern, K. B. (2017, February). Refractory Cardiac Arrest: From the Field to the Cath Lab. Eagles Creek EMS Medical Directors program. Dallas, TX.
• Kern, K. B. (2017, January). Cardiac Resuscitation in 2017. Hilo Medical Center Family Practice Grand Rounds. Hilo, HI.
• Kern, K. B. (2017, January). Cardiac Resuscitation: Everything EMS Needs to Know in 2017. Hilo Medical Center. Hilo, HI.
• Kern, K. B. (2017, January). Discovering More Ways to Cheat Death: Resuscitation Research. Sarver Heart Center 30th Anniversary Lecture Series. Tucson, AZ.
• Kern, K. B. (2017, January). Resuscitation Officers Training Program: Ho’loa hou (Revive) The Heart: Ultrasound, Cath/PCI, and E-CPR. 46th Critical Care Conference of the Society of Criitical Care Mediciine. Honolulu, HI.
• Kern, K. B. (2017, June). Improving Survival in Out-of-Hospital Cardiac Arrest: A Survivor’s Story. Complex Cardiovascular Catheter Therapeutics (C3) 2017. Orlando, FL.
• Kern, K. B. (2017, June). Meet the Expert: How to Implant and Manage ECMO for Refractory Cardiac Arrest. Complex Cardiovascular Catheter Therapeutics (C3) 2017. Orlando, FL.
• Kern, K. B. (2017, March). The Importance of Emergency Cardiac Centers. 9th Annual Northeast Georgia STEMISUMMIT2017. Chateau Elan, Braselton, GA.
• Kern, K. B. (2017, May). Defibrillation: What’s New?. 11th International Spark of Life Conference. Adelaide, Australia.
• Kern, K. B. (2017, May). Post Resuscitation Care: Changing the Status Quo. 11th Annual Resuscitatino & Critical Interventions Science (RACI) Conference. Anchorage, AK.
• Kern, K. B. (2017, May). Refractory VFCA in the Cath Lab & Field. 11th Annual Resuscitatino & Critical Interventions Science (RACI) Conference. Anchorage, AK.
• Kern, K. B. (2017, May). Seattle: Too Good to be True vs No it’s Not. 11th International Spark of Life Conference. Adelaide, Australia.
• Kern, K. B. (2017, November). Chest Compression-Only CPR. 2nd International CPR Conference. Jeddah, Kingdom of Saudi Arabia.
• Kern, K. B. (2017, November). Post Resuscitation Care, Particularly the Role of Early Coronary Angiography and PCI Post Arrest. 2nd International CPR Conference. Jeddah, Kingdom of Saudi Arabia.
• Kern, K. B. (2017, November). What’s New in Defibrillation. 2nd International CPR Conference. Jeddah, Kingdom of Saudi Arabia.
• Kern, K. B. (2017, October). Cardiac Arrest-Statistically Speaking. Extending Treatment with ECPR Symposium. Bellevue, WA.
• Kern, K. B. (2017, October). Death In and After the Cath Lab: Whose Counting?. Extending Treatment with ECPR Symposium. Bellevue, WA.
• Kern, K. B., & Kern, K. B. (2017, December). Cardiology Issues for Resuscitation Officers. Resuscitation Officers Program Emergency Cardiovascular Care Update (ECCU). New Orleans, LA.
• Kern, K. B. (2016, April). The Decision to Perform Emergency Coronary Angiography in Patients with Cardiac Arrest and STEMI Should be Individualized. 65th Annual Scientific Sessions of the American College of Cardiology. Chicago, IL.
• Kern, K. B. (2016, February). “Cardiocerebral Resuscitation: What is it and Why?”. 18th Annual CardioVascular Institute of Northern Colorado Heart Conference. Loveland, CO.
• Kern, K. B. (2016, February). “Commentary of Chest Compression Ony CPR by Laypersons”. 2016 Singapore EMS/International Resuscitation Symposium. Singapore.
• Kern, K. B. (2016, February). “How to Resuscitate Patients in the Cath Lab”. 2016 Singapore EMS/International Resuscitation Symposium. Singapore.
• Kern, K. B. (2016, February). “PCI After Return of Spontaneous Circulation”. 2016 Singapore EMS/International Resuscitation Symposium. Singapore.
• Kern, K. B. (2016, January). “Would You Know How To Respond in Case of Sudden Cardiac Arrest?”. Sarver Heart Center Green Valley Lecture Series. Green Valley, AZ: Sarver Heart Center.
• Kern, K. B. (2016, July). Case Presentation: “Not Just Atherosclerosis”. Complex Cardiovascular Catheter Therapeutics Conference (C3). Orlando, FL.
• Kern, K. B. (2016, July). Management of the Cardiac Arrest Victim. Complex Cardiovascular Catheter Therapeutics Conference (C3).
• Kern, K. B. (2016, July). No STEMI Post-Arrest. Complex Cardiovascular Catheter Therapeutics Conference (C3). Orlando, FL.
• Kern, K. B. (2016, June). Cardiac Arrest Centers Make a Difference: Early In-hospital Management and the Role of Interventional Cardiology. Blockkurs II / 2016 Emergency Medicine, University of Basel. Basel, Switzerland.
• Kern, K. B. (2016, June). New Concepts in Resuscitation Science Research. Blockkurs II / 2016 Emergency Medicine, University of Basel. Basel, Switzerland.
• Kern, K. B. (2016, June). Use of the Cath Lab in the Treatment of Cardiac Arrest. Minnesota Resuscitation Consortium 2016 Resuscitation Academy. Minneapolis, MN.
• Kern, K. B. (2016, March). The Role of Mechanical CPR In and On-the-Way to the Cardiac Catheterization Laboratory. 80th Annual Scientific Meeting of the Japanese Circulation Society. Singapore.
• Kern, K. B. (2016, May). The Role of Mechanical CPR Devices in and on the way to the Cath Lab. 10th Annual Resuscitation and Critical Interventions (RACI) Conference. Anchorage, AK.
• Kern, K. B. (2016, May). Use of the Cath Lab in the Treatment of Cardiac Arrest. 10th Annual Resuscitation and Critical Interventions (RACI) Conference. Anchorage, AK.
• Kern, K. B. (2016, October). Cardiac Resuscitation: Strategies to Improve Good Outcomes. 26th Annual Cardiology & Electrophysiology Symposium. Sacramento, CA: Dignity Health.
• Kern, K. B. (2016, September). Chest Compression-Only CPR-Where and How it Happened. Sunrise Chapter, Rotary International. Tucson, AZ.
• Kern, K. B. (2016, September). Combining Target Temperature Management and recanalization after STEMI associated with Cardiac Arrest. 6th International Hypothermia and Temperture Management Symposium. Philadelphia, PA.
• Kern, K. B. (2016, Sprint). Cardiac Songs (Auscultation Course). American College of Cardiology. Chicago, IL: ACC.
• Kern, K. B. (2015, Apr). "Post resuscitation outcomes in patients with and without ST elevation: The importance of coronary angiographic findings”. Weil Institute of Critical Care Medicine Wolf Creek Conference XIII. Shanghai, China.
• Kern, K. B. (2015, Apr). “The role of early postarrest coronary angiography and PCI”. 79th Annual Scientific Meeting of the Japanese Circulation Society. Osaka, Japan.
• Kern, K. B. (2015, Dec). “The New Acute Coronary Syndrome Guidelines for EMS and Hospitals: Implementing with Precision and Quality”. ECCU 2015: The New 2015 Resuscitation Guidelines: Translating Science into Survival. San Diego, CA.
• Kern, K. B. (2015, Dec). ”Cardiology Issues: Resuscitation Officer Program”. ECCU 2015: The New 2015 Resuscitation Guidelines: Translating Science into Survival. San Diego, CA: Citizens CPR Foundation.
• Kern, K. B. (2015, Feb). Cool Catheter Procedures. Heathy Heart Day. Sarver Heart Center - University of Arizona: Sarver Heart Center.
• Kern, K. B. (2015, Feb). “Go with the Flow: Catheter-based Therapy for Your Heart". Sarver Heart Center Green Valley Lecture Series. Green Valley, AZ: Sarver Heart Center.
• Kern, K. B. (2015, Jan). "Therapeutic Hypothermia Post Cardiac Arrest: Is Therea Standard of Expected Care?”. 15th Annual Multispeciality Conference on Medical Negligence & Risk Management. Kona, Hawaii.
• Kern, K. B. (2015, Jan). “Cooling and Cathing” Post Resuscitation for Myocardial Infarction: Evolving Guidelines and Standards. 15th Annual Multispeciality Conference on Medical Negligence & Risk Management. Kona, Hawaii.
• Kern, K. B. (2015, Jan). “Resuscitation Practice for Out-of-Hospital Sudden Death: What Can Go Wrong?”. 15th Annual Multispeciality Conference on Medical Negligence & Risk Management. Kona, Hawaii.
• Kern, K. B. (2015, Jun). “Angiographic findings post resuscitation in the cath lab”. Complex Cardiovascular Catheter Therapeutics Conference (C3). Orlando, FL.
• Kern, K. B. (2015, Jun). “Community BLS is the foundation for successful post resuscitation care”. Complex Cardiovascular Catheter Therapeutics Conference (C3). Orlando, FL.
• Kern, K. B. (2015, Mar). “Chest Compression-Only: Possible Answer for Improving Bystander CPR in Minority Communities”. Delta Sigma Theta Sorority Sarver Heart Center Tour. Sarver Heart Center - University of Arizona.
• Kern, K. B. (2015, Mar). “Physiology of cardiac arrest- How to be awesome”. Scottish Cardiac Arrest Symposium 2015. Edinburgh, Scotland.
• Kern, K. B. (2015, Nov). “Chest Compression-Only CPR for First Responders”. INCOR Institute 2015 CPR Resucitation Guidelines Symposium. Sao Paulo, Brazil: University of Sao Paulo.
• Kern, K. B. (2015, Nov). “Development of the 2015 Guidelines: Example of Post Arrest Coronary Angiography”. INCOR Institute 2015 CPR Resucitation Guidelines Symposium. Sao Paulo, Brazil: University of Sao Paulo.
• Kern, K. B. (2015, Nov). “Hypothermia: To Cool or Not to Cool--- That is the Question for 2015-16". INCOR Institute 2015 CPR Resucitation Guidelines Symposium. Sao Paulo, Brazil: University of Sao Paulo.

Poster Presentations

• Pineda, J. T., Srinivasan, S., Blythe, A., Koester, B. S., Bhargava, R., Kern, K. B., & Lee, K. S. (2018, Sep). Effect of Allura Xpef FD20 ECO X-Ray image processing on radiation reduction during cardiac cardiac catheterization: A single center 717 case experience. Transcatheter Therapeutics (TCT). San Diego, CA.
• Truong, H., Lotun, K., Smith, N., Rao, P., Gianotto-Oliveira, R., Rivera-Zotigh, J., Done, A., Talwar, S., Tran, T., Hsu, C., & Kern, K. B. (2017, November). Combining Mechanical Chest Compressions With a Percutaneous Left Ventricular Assist Device Improves Favorable Neurological Function After Cardiac Arrest in a Large Animal Catheterization Laboratory.. Circulation.
• Kern, M., Chatelain, S., Rao, P., Bien, T., Smith, N., Oliveira, R., Cha, K., Kern, K. B., Truong, H., & Lotun, K. (2016, Fall). Mechanical Chest Compression or Percutaneous Left Ventricular Assist Devices Improve Survival In Cardiac Arrest in the Cath Lab. American Heart Association Scientific Sessions. New Orleans, LA.
• Boscom, K., Dziodizo, J., Vasaiwala, S., Mooney, M., Patel, N., McPherson, J., McMullan, P., Unger, B., Nielsen, N., Kern, K. B., Friberg, H., & Seder, D. (2015, Nov). Validation of a novel prediction tool for circulatory etiology death after cardiac arrest. American Heart Association Annual Scientific Sessions. Orlando, FL: AHA.
• Lotun, K., Shetty, R., Ellingson, C., & Kern, K. B. (2015, Nov). Optimal hemodynamic support for emergency coronary intervention during refractory cardiac arrest. AHA Annual Scientific Sessions 2015. Orlando, FL: AHA.
• Patel, N., Nair, S., Mooney, M., McPherson, J., Seder, D., Cash, M., Young, M., Unger, B., & Kern, K. B. (2015, Nov). Risk of stent thrombosis in cardiac arrest patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention and therapeutic hypothermia: International Cardiac Arrest Registry. AHA Annual Scientific Sessions. Orlando, FL: AHA.
• Lee, K. S., Lee, J., Irbaz Bin Riaz, F., Husnain, M., Riaz, H., Lotun, K., & Kern, K. B. (2013, October). STRUT LEVEL OPTICAL COHERENCE TOMOGRAPHY EVALUATION OF CORONARY STENT STRUT COVERAGE TEMPORAL TRENDS: A SYSTEMATIC REVIEW. TCT MEETING. San Francisco, CA.
• Habibzadeh, R., Kern, K. B., & Lotun, K. (2012, October). CHALLENGING CASE SERIES - FLOATING CORONARY STENT. TCT Meeting. Miami, FL.

Reviews

• Klee, T. E., & Kern, K. B. (2021. A review of ECMO for cardiac arrest.(p. 100083).
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  Cardiac arrest is an important public health concern, affecting an estimated 356,500 people in the out-of-hospital setting and 209,000 people in the in-hospital setting each year. The causes of cardiac arrest include acute coronary syndromes, pulmonary embolism, dyskalemia, respiratory failure, hypovolemia, sepsis, and poisoning among many others. In order to tackle the enormous issue of high mortality among sufferers of cardiac arrest, ongoing research has been seeking improved treatment protocols and novel therapies. One of the mechanical devices that has been increasingly utilized for cardiac arrest is venoarterial extracorporeal membrane oxygenation (VA-ECMO). Presently there is only one published randomized controlled trial examining the use of VA-ECMO as part of cardiopulmonary resuscitation (CPR), a process referred to as extracorporeal cardiopulmonary resuscitation (ECPR). Recently there has been significant progress in providing ECPR for refractory cardiac arrest patients. This narrative review seeks to outline the use of ECPR for both in-hospital and out-of-hospital cardiac arrest, as well as provide information on the expected outcomes associated with its use.
• Vetrovec, G. W., Block, P. C., Helmy, T., Kern, K. B., Lawson, B. D., Lim, M. J., Lipinski, M. J., Patel, R., & Robert, A. M. (2019. Important Trial Results for Interventional Cardiology from ACC 19.
• Rao, P., & Kern, K. B. (2018. Improving community survival rates from out-of-hospital cardiac arrest(pp 79-84).
• Ahmed, H., P, R., & Kern, K. B. (2017. The Role of Cardiac Catheterization after Cardiac Arrest.
• Kern, K. B. (2017. Trends and Changes in Cardiac Resuscitation(pp 2 - 7).
• William, P., Rao, P., Kanakadandi, U., Ascencio, A., & Kern, K. B. (2016. Mechanical CPR in and on the way to the cardiac catheterization laboratory..
• Kern, K. B. (2015. Usefulness of cardiac arrest centers: Extending lifesaving post resuscitation therapies-The Arizona experience(pp 1156-1163.). Circulation Japan.
• Kern, K. B. (2015. Usefulness of cardiac arrest centers: Extending lifesaving post resuscitation therapies: The Arizona experience..
• Truong, H. T., Low, L. S., & Kern, K. B. (2015. Current Approaches to Cardiopulmonary Resuscitation(pp 275-313). Volume 40.
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  Real progress has been made in improving long-term outcome after out-of-hospital cardiac arrest in the past 10 years. Many communities have doubled their survival-to-hospital-discharge rate during this period. Common features of such successful programs include the following: (1) 911 dispatcher-assisted cardiopulmonary resuscitation (CPR) instruction, (2) bystander chest compression-only CPR program, (3) public access defibrillation, including targeted automated external defibrillator programs, (4) renewed emphasis on minimally interrupted chest compressions by emergency medical services responders, and (5) aggressive postresuscitation care, including targeted temperature management and early coronary angiography and intervention. An important lesson from these successful community efforts is that multiple, simultaneous changes to the local cardiac arrest response system are necessary to improve survival. The next exciting step in this quest appears to be the treatment of refractory cardiac arrest with the combination of mechanical CPR, intra-arrest hypothermia, extracorporeal CPR with mechanical circulatory support devices, and early coronary intervention.
• Babbs, C. F., Sack, J. B., & Kern, K. B. (1994. Interposed abdominal compression as an adjunct to cardiopulmonary resuscitation.(pp 412-421). 27.
• Kern, K. B., & Fenster, P. E. (1983. Assessing antiarrhythmia therapy with programmed ventricular stimulation.(pp 91-94). 8.

Creative Productions

• Kern, K. B. (2017. The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period.PracticeUpdate. http://www.practiceupdate.com/content/post-resuscitation-ecg-in-patients-with-st-segment-changes-in-the-immediate-post-cardiac-arrest-period/50632/65/2/1
• Kern, K. B., Shah, N., Agarwal, V., Chaudhary, R., Garg, J., & Patel, N. (2017. Risk of Stent Thrombosis in Patients with AMI and Cardiac Arrest Treated with Hypothermia.American College of Cardiology. http://www.acc.org/lastest-in-cardiology/articels/2017/07/25/14/30/risk-of-stent-thrombosis-in-patients-with-ami-and-cardiac-arrest-treated-with-hypothermia
• Kern, K. B. (2007. 2010 Goals for Heart Disease and Stroke Prevention: Are We There Yet?. American College of Cardiology Cardiosource ACCEL.

Others

• Acharya, D., Rajapreyar, I., & Kern, K. (2021, Nov). Editorial: Cardiogenic Shock: Basic and Clinical Considerations. Frontiers in cardiovascular medicine.
• Kern, K. B., Shetty, R., Hutchinson, M., Harhash, A. A., Reddy, S., Huang-Tsang, J., Natarajan, B., & Balakrishnan, M. (2017, Spring). Does ST segment elevation in lead AVR correlate with left main occlusion?. Journal of American College of Cardiology.
• Kern, K. B., Truong, H., Lotun, K., Smith, N., Rao, P., Gianotto-Oliveira, R., RIvera-Zotigh, J. M., Talwar, S., Tran, T., & Hsu, C. (2017, Spring). Combining mechanical chest compressions with a percutaneous left ventricular assist device improves favorable neurological outcome after cardiac arrest in a large animal catheterization laboratory.. Circulation.
• Kern, M., Chatelain, S., Rao, P., Bien, T., Smith, N., Oliveira, R., Cha, K., Kern, K. B., Lotun, K., & Truong, H. (2016, January). Mechanical Chest Compression or Percutaneous Left Ventricular Assist Devices Improve Survival In Cardiac Arrest in the Cath Lab..
• Kern, K. B., & Lotun, K. (2015, December). How much is enough?. Circulation Cardiovascular Intervention.
• Kern, K. B., & Lotun, K. (2015, Feb). How much is enough?. Circ Cardiovasc Interv.
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  Invited Editorial
• Berg, R. A., Hilwig, R. W., Zuercher, M., Berg, M. D., Indik, J. H., Ewy, G. A., & Kern, K. B. (2007, Jan). Pre-shock CPR worsens outcome from circulatory phase VF with acute coronary artery obstruction in swine.. Circulation.
• Gonzalez, M. M., Berg, R. A., Nadkarni, V. M., Vianna, C. B., Kern, K. B., Timerman, S., & Ramires, J. A. (2007, Jan). Left ventricular systolic function and outcome following in-hospital cardiac arrest.. Circulation.
• Indik, J. H., Donnerstein, R. L., Feigelman, J., Hilwig, R. W., Zuercher, M., Kern, K. B., Berg, M. D., & Berg, R. A. (2007, Jan). Waveform characteristics of ventricular fibrillation are altered in post-myocardial infarction swine.. Circulation.
• Indik, J. H., Peters, C. M., Donnerstein, R. L., Kern, K. B., Ott, P., & Berg, R. A. (2007, Jan). Direction of signal recording affects amplitude based measures of venticular fibrillation in humans undergoing defibrillation testing during ICD implantation.Direction of signal recording affects amplitude based measures of venticular fibrillation in humans undergoing defibrillation testing during ICD implantation.. Circulation.
• Kern, K. B., Cragun, D., Zuercher, M., Hilwig, R. W., Berg, R. A., & Ewy, G. A. (2007, Jan). Post resuscitation myocardial microcirculatory dysfunction is ameliorated with platelet glycoprotein Iib/IIIa inhibition.. Circulation.
• Zuercher, M., Hilwig, R. W., Nysaether, J., Nadkarni, V. M., Berg, M. D., Ewy, G. A., Kern, K. B., & Berg, R. A. (2007, Jan). A sternal accelerometer does not impair hemodynamics during piglet CPR.. Circulation.
• Zuercher, M., Hilwig, R. W., Nysaether, J., Nadkarni, V. M., Berg, M. D., Ewy, G. A., Kern, K. B., & Berg, R. A. (2007, Jan). Incomplete chest recoil during piglet CPR worsens hemodynamics.. Circulation.
• Kern, K. B., Hilwig, R. W., Berg, R. A., & Ewy, G. A. (1999, Jan). Intra-aortic balloon counterpulsation vs. dobutamine in the treatment of post resuscitation left ventricular dysfunction.. Journal of the American College of Cardiology.
• Kern, K. B., Hilwig, R. W., Berg, R. A., Schock, R. B., & Ewy, G. A. (1999, Jan). Optimizing ventilation with phased chest and abdominal compression-decompression (Lifestick) CPR.. Journal of the American College of Cardiology.
• Kern, K. B. (1989, Jan). ECG Laboratory.
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  Consultant, Central