Increasing National Institutes of Health Funding for Cardiac Arrest Research

I t is a truth universally acknowledged that an agency in possession of funds must be in need of a worthy cause. In this issue of JAHA, Coute et al review the funding record of the National Institutes of Health (NIH), the largest funder of biomedical research in the world, to assess its investment in cardiac arrest research. These authors used a very systematic and replicable strategy to sort grants. It appears that about $29 million per year of the $30 billion total budget was invested by NIH specifically to study cardiac arrest. Cardiac arrest has huge public health impact: This syndrome accounts for 1 death in 6 and is the third leading cause of death in the United States. The explicit message is that cardiac arrest research is worthy of more funding than it has received in the past and that NIH should increase the investment in this research. This conclusion contains several assumptions that we should examine. First, are the results accurate? The authors used a reasonable approach to measure direct investment in cardiac arrest research. Cardiac arrest is the interruption of heart pumping activity that requires mechanical support or CPR. Multiple methods for CPR exist presently, including manual chest compression, mechanical compressions, and extracorporeal life support. Many patients die because these techniques do not restart the heart. The authors identified grants using the NIH public database and included grants based on their abstracts that specifically addressed cardiac arrest or CPR. When CPR does restore heart function, patients may have dysfunction in multiple organ systems as a result of ischemia–reperfusion, and injury to the brain accounts for the majority of post-CPR mortality. To study this particular situation, the authors also included projects that studied global brain ischemia. This approach seems very specific for identifying grants addressing cardiac arrest. Second, is it accurate that grants that do not explicitly mention cardiac arrest are not addressing this syndrome? This assumption may be overly simplistic because cardiac arrest is a situation and a final common pathway for death in many diseases. In fact, would any research that reduces mortality from a given disease indirectly prevent sudden cardiac arrest? Research that improves survival in coronary artery disease, respiratory failure, drug overdose, or bleeding would all reduce or delay the incidence of cardiac arrest for an individual. Similarly, post–cardiac arrest patients are a specific subset of critically ill patients with cardiogenic shock, respiratory failure, and organ dysfunction. Perhaps any research on these situations is, in fact, also “cardiac arrest related.” The present analysis may not be sensitive for finding all of these projects. Prospective studies asking whether work is relevant to cardiac arrest may be a more sensitive way to ask this question, much in the same way that we ask for American Heart Association grants if a project is “stroke related.” Third, is cardiac arrest really more important than other situations? Every investigator, physician, patient, and group does and should advocate for more research about the particular problem at hand; however, the general public and policy makers seem to underestimate the high burden of mortality from cardiac arrest. In public discussion and media, sudden death is often referred to as a “massive heart attack,” confusing the syndrome with other heart disease. For surviving families, sudden death may be perceived as “dying naturally.” Perhaps sudden death is so common in our society that the public assumes it is natural. Out of compassion, medical professionals are loath to correct this perception or to suggest that an individual death might have been preventable. Most regrettably, patients for whom resuscitation is not effective do not survive long enough to become advocates for more research on their disease. Previous reviews noted that the amount of research on resuscitation is low relative to the public health impact of cardiac arrest. The Institute of Medicine recommended that efforts begin to The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. From the Department of Emergency Medicine, University of Pittsburgh, PA. Correspondence to: Clifton W. Callaway, MD, PhD, Department of Emergency Medicine, University of Pittsburgh, 400A Iroquois, 3600 Forbes Avenue, Pittsburgh, PA 15260. E-mail: [email protected] J Am Heart Assoc. 2017;6:e006739. DOI: 10.1161/JAHA.117.006739. a 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.