Emory at the Atlanta VAMC: Helping patients through research

Maziar Zafari
Outcomes for sudden cardiac arrest have always been dismal, even for those occurring in medical settings. Maziar Zafari’s research changed outcomes for cardiopulmonary resuscitation at the Atlanta VA Medical Center, improving survival so much that his strategies were copied by other VA facilities across the country and have been referenced in the American Heart Association’s CPR guidelines.

 

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Veteran Mike Pafford came early for the appointment with his diabetes doctor at the Atlanta VA Medical Center, just so he could have lunch on the sunny terrace.

When he suddenly fell off his chair, unconscious, his wife screamed for help.

A nurse’s aide nearby knew exactly what to do. Following policy, all nonphysician staff have been trained and empowered to respond to cardiac emergencies: If you see the emergency first, you begin CPR, no waiting around for someone else. Minutes and seconds count. A nurse called code 99—patient with no pulse—and joined the CPR effort. Members of the code 99 team arrived quickly and took over.

In the cardiac ICU, Pafford remained comatose. More than an hour of CPR and repeated defibrillations for an unstable heart rhythm had brought back his pulse. But could he be brought back to the life he had before?

Since 2011, under the direction of Emory cardiologist Maziar Zafari, who is chief of cardiology at the Atlanta VAMC, the hospital has been one of relatively few to use near-infrared spectroscopy to monitor the amount of oxygen-carrying blood reaching the deep brain during CPR and post-cardiac arrest in cases like Pafford’s. Zafari has shown that the test, which is noninvasive and relatively inexpensive, may be effective in monitoring survivors of cardiac arrest to avoid invasive and ineffective procedures.

Pafford’s readings indicated that he was neurologically intact and that he would benefit from further therapy. He was taken immediately to the cardiac cath lab, where the interventional cardiology team opened his blocked vessel. To prevent brain damage, the team induced mild hypothermia, lowering the oxygen demands of the brain. Two weeks later, Pafford left the hospital, fully functional, with no cognitive deficits.

Zafari sees cases like Pafford’s over and over at the VAMC. Pafford’s records, with his permission, are now part of a cardiovascular biobank that Zafari and his colleagues are building—with more than 6,000 cases—to determine genetic markers and other factors contributing to heart disease, its severity, response to treatment, and related problems like mental stress and depression.

       
   

Emory and the Atlanta VA Medical Center have been affiliated since 1946. In addition to a backyard, they share a mission to care for veterans and to conduct research that will continually improve this care. Emory investigators contribute to a diverse spectrum of research at the Atlanta VA that brought in more than $13 million in VA and $11 million in non-VA funding last year.

 

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